Early Vitamin D Repletion in Critically Ill Adults: A Prospective Dose-Stratified Quasi-Experimental Study

Abstract

Vitamin D deficiency is frequent in critical illness, but whether rapid biochemical correction translates into clinical benefit remains uncertain. This prospective, non-randomized, dose-stratified quasi-experimental study evaluated 43 critically ill adults with serum 25-hydroxyvitamin D [25(OH)D] <30 ng/mL in an Indonesian intensive care unit. Participants were stratified as vitamin D deficient (<20 ng/mL) or insufficient (20–29 ng/mL) and received cholecalciferol 10,000 or 50,000 IU/day for three consecutive days. The primary outcome was the change in serum 25(OH)D concentration from baseline to day 4. Secondary outcomes were change in Sequential Organ Failure Assessment (SOFA) score from baseline to day 4, ventilator-free days at day 28 (VFD28), and 28-day all-cause mortality. Serum 25(OH)D increased significantly in all four groups (all p≤0.011), with a significant between-group difference in change (p=0.002). A day-4 25(OH)D concentration ≥30 ng/mL was achieved in 53.5% of participants overall and more frequently in the 50,000-IU groups. SOFA scores decreased significantly within all groups, but the between-group difference in ΔSOFA did not reach statistical significance (p=0.051). No significant between-group differences were observed in VFD28 (p=0.686), or 28-day mortality (p=0.884). Short-term 50,000 IU/day cholecalciferol produced faster biochemical repletion than 10,000 IU/day, but corresponding superiority in short-term clinical outcomes was not demonstrated.