Vitamin D Deficiency in Traumatic Brain Injury and Its Relationship with Severity of Injury and Quality of Life: A Prospective, Observational Study.
This single-center prospective observational study aims to describe the prevalence of vitamin D deficiency (VDD) in the traumatic brain injury (TBI) population and identify any relationship between vitamin D and severity of head injury or quality of life. One hundred twenty-four TBI patients had serum vitamin D (25-OHD) levels measured at the local post-TBI endocrine screening clinic over 20 months. Quality of Life after Brain Injury questionnaires were completed by the patient concurrently. A multivariate regressional analysis was performed, controlling for age, season, ethnicity, time since injury, TBI severity, and gender. A total of 34% (n = 42) of the cohort were vitamin D deficient (25-OHD <25 nmol/L), with a further 23% (n = 29) having insufficient levels (25-OHD 25-50 nmol/L). Vitamin D was significantly lower in patients with severe TBI than in patients with mild TBI (n = 95; p = 0.03; confidence interval [CI] 95% -23.60 to -1.21; mean effect size 12.40 nmol/L). There was a trend for self-reported quality of life to be better in patients with optimum vitamin D levels than in patients with deficient vitamin D levels, controlling for severity of injury (n = 81; p = 0.05; CI 95% -0.07 to 21.27). This is the first study to identify a significant relationship between vitamin D levels and severity of head injury. Clinicians should actively screen for and treat VDD in head-injured patients to reduce the risk of further morbidity, such as osteomalacia and cardiovascular disease. Future research should establish the natural history of vitamin D levels following TBI to identify at which stage VDD develops and whether vitamin D replacement could have a beneficial effect on recovery and quality of life.
1 National Institute for Health Research Surgical Reconstruction and Microbiology Research Center, Queen Elizabeth Hospital , Birmingham, United Kingdom .
Emma
E
Toman
2 Department of Medical Statistics, University of Birmingham , Birmingham, United Kingdom .
Jonathon R B
JR
Bishop
3 Surgical Reconstruction and Microbiology Center, Queen Elizabeth Hospital , Birmingham, United Kingdom .
David J
DJ
Davies
4 Department of Neurosurgical Trauma, Queen Elizabeth Hospital , Birmingham, United Kingdom .
Zhangjie
Z
Su
5 Department of Endocrinology, Queen Elizabeth Hospital , Birmingham, United Kingdom .
Sherwin
S
Criseno
5 Department of Endocrinology, Queen Elizabeth Hospital , Birmingham, United Kingdom .
Andrea
A
Mason
5 Department of Endocrinology, Queen Elizabeth Hospital , Birmingham, United Kingdom .
Andrew A
AA
Toogood
6 Institute of Inflammation and Ageing, University of Birmingham , Birmingham, United Kingdom .
Antonio
A
Belli
D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000503:physiopathology*; D002112:Calcifediol / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000097:blood* / Q000453:epidemiology; D055815:Young Adult
D002112:Calcifediol
endocrinology; neurotrauma; traumatic brain injury; vitamin D; vitamin D deficiency