Esophageal Cancer surgery helped by 300,000 IU of Vitamin D – RCT

Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial.

Crit Care Med. 2018 Sep 14. doi: 10.1097/CCM.0000000000003405. [Epub ahead of print]

Parekh D1,2,3, Dancer RCA1,4, Scott A1, D'Souza VK1, Howells PA1, Mahida RY1, Tang JCY5, Cooper MS6, Fraser WD5, Tan L7, Gao F1,4, Martineau AR 8, Tucker O1,4, Perkins GD3,4, Thickett DR1,2.

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OBJECTIVES:

Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.

DESIGN: A double-blind, randomized, placebo-controlled trial.

SETTING: Three large U.K. university hospitals.

PATIENTS: Seventy-nine adult patients undergoing elective esophagectomy were randomized.

INTERVENTIONS: A single oral preoperative (3-14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.

MEASUREMENTS AND MAIN RESULTS:

Primary outcome was change in extravascular lung water index at the end of esophagectomy.

Secondary outcomes included

• PaO2:FIO2 ratio,

• development of lung injury,

• ventilator and organ-failure free days,

• 28 and 90 day survival,

• safety of cholecalciferol supplementation,

• plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein),

• pulmonary vascular permeability index, and

• extravascular lung water index day 1 postoperatively.

An exploratory study measured biomarkers of alveolar-capillary inflammation and injury.

Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4-1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4-1.2 mL/kg]; p = 0.059).

Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0-0.7] vs cholecalciferol 0.1 [interquartile range, -0.15 to -0.35]; p = 0.027).

Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.

CONCLUSIONS:

High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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