Association of Vitamin D Deficiency with Profound Cardiogenic Shock in Patients Resuscitated from Sudden Cardiac Arrest

Abstract

Background: Vitamin D deficiency is associated with various cardiovascular diseases, including sudden cardiac arrest (SCA). Profound cardiogenic shock is associated with morbidity and mortality in patients with SCA. This study investigated the association of vitamin D deficiency with profound cardiogenic shock in patients resuscitated from SCA. Materials and Methods: We enrolled patients who were successfully resuscitated from out-of-hospital cardiac arrests of a presumed cardiac cause. Profound cardiogenic shock was defined as refractory hypotension requiring high-dose vasopressor infusion (norepinephrine >0.5mcg/kg/min) despite adequate intravascular volume replacement. Vitamin D levels were measured as plasma 25(OH)D concentrations and severe vitamin D deficiency was defined as 25(OH)D <10ng/mL. Results: A total of 237 subjects (179 men (76%), mean age 56.5±16.5 years) were included in this study. The first monitored rhythm was shockable in 160 subjects (68%). Mean arrest time and CPR times were 25.6±15.7 and 22.8±15.0minutes, respectively. Profound cardiogenic shock was observed in 100 subjects (42%). The mean vitamin D level was 12.3±6.7ng/mL, and vitamin D deficiency was diagnosed in 109 subjects (46%). In profound cardiogenic shock subjects, vitamin D levels were significantly lower (10.7±7.0 vs. 13.4±6.2ng/mL, p=0.002) and severe vitamin D deficiency was observed more frequently (63% vs. 34%, p<0.001). Subjects with profound cardiogenic shock were likely to have longer arrest times (29.5±17.0 vs. 22.7±14.0minutes, p=0.001), left ventricular systolic dysfunction (LVEF<40%, 73% vs. 38%, p<0.001), and baseline renal dysfunction (65% vs. 37%, p<0.001). Multivariate logistic analysis indicated that vitamin D deficiency was significantly associated with profound cardiogenic shock after SCA (OR 2.71, 95% CI 1.42-5.18, p=0.003) after adjusting for confounding variables. Conclusions: Severe vitamin D deficiency was strongly associated with profound cardiogenic shock and mortality in patients resuscitated from SCA. © 2019 Wolters Kluwer Health, Inc. All rights reserved.