Effects of vitamin D and angiopoetin 1-2 levels on survival in intensive care unit patients

Introduction and aim: Many studies have researched and identified some factors affecting ICU survival and investigations on this cardinal topic stated, significant situations moderating this critical issue. By the way, research on this item is so popular and should be progressed till satisfactorily results will be achieved. In this study, we searched the effects of Vitamin D , Angiopoietin 1 and Angiopoietin 2 on mortality in ICU patients. Material and Method: This study included 156 patients who had admitted in ICU of Department of Anesthesiology, Celal Bayar University, School of Medicine; between June 2016 - August 2017. The Vitamin D, Angiopoietin 1 and Angiopoietin 2 levels were measured from blood samples taken in the first 24 hours of patients' admission. The demographical data, SOFA scores, APACHE II scores, Glasgow Coma Scores, lactate, calcium, calcitonin, PTH and phosphor values, infection status and discharge/mortality ratios were also recorded and compared with Vitamin D, Angiopoietin 1 and Angiopoietin 2 values. The student's t test, x-square , mann-whitney U and Pearson's corelations tests were used in statistical analysis. Results : The mean plasma level of vitamin D was 8,32±8,71 ng/ml in ICU admission. Survival rates of 110 patients (%70,5) who have had low vitamin-D values were lower than 46 patients (%29,5) whose vitamin D values were found higher than 8,32±8,71 ng/ml; the difference between these two groups were statistically significant (p<0,05). When the levels of AP1 and AP2 compared with survival rates; AP1 levels were found to be in direct relation with high survival rates and on the other hand, AP2 levels were found in inverse relation with high survival (respectively p<0,05 and p<0,0001). Discussion: Currently physicians use a variety of tools for example; SOFA, APACHE II, lactate and procalcitonin for predicting clinical outcomes. Vitamin D, AP1 and AP2 has been studied and these parameters were found to be in close relation of ICU survival. Vitamin D has direct effects on calcium and bone homeostasis and it's deficiency is associated with the development of cardiovascular disorders, atherosclerotic calcification, renin – angiotensin system disorders, immune system malfunctions so low vitamin D levels has been found to be particularly associated with mortality in ICU patients. Angiopoietin 1 has a critical role in endothelial maturation and vascular stability. Increased plasma Angiopoietin 2 levels are associated with increased fluid overload, hepatic and coagulation disorders, acute kidney injury, plasma cytokines elevations and increased vascular leakage; so it has been directly found to be in close correlation with organ dysfunction. Otherwise multivariate logistic regression analyses of vitamin D-AP1-AP2, all three of them together, has not been studied in respect of their correlation for predicting mortality of ICU. To the best of our knowledge, this is the first clinical study to demonstrate that vitamin D deficiency and low AP1 and high AP2 levels are associated with poor ICU survival rates. Conclusion: Multicenter studies should be planned to assess the actual value of vitamin D, AP1 and AP2 levels, measured at ICU admission, for prediction of critical care patients' survival.