Premium
Venous Thromboembolism is Associated With Lack of Vitamin D Supplementation in Patients With Spinal Cord Injury and Low Vitamin D Levels
Author(s) -
Ehsanian Reza,
Timmerman Molly A.,
Wright Jerry M.,
McKenna Stephen,
Dirlikov Ben,
Crew James
Publication year - 2019
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2018.09.038
Subject(s) - medicine , vitamin d and neurology , incidence (geometry) , rehabilitation , population , spinal cord injury , vitamin , vitamin d deficiency , cohort , retrospective cohort study , gastroenterology , physical therapy , spinal cord , physics , environmental health , psychiatry , optics
Background The role of vitamin D in the pathogenesis of venous thromboembolism (VTE) and prevalence of low vitamin D (LVitD) in spinal cord injury (SCI) has motivated vitamin D testing and supplementation. This is an exploratory study of data collected at a time before the routine clinical practice of vitamin D supplementation, allowing for evaluation of the natural history of vitamin D levels in patients with SCI. Objective To determine if vitamin D supplementation in persons with SCI and LVitD levels is associated with decreased prevalence of VTE. Design Retrospective cohort study. Setting Rehabilitation Center at a Level I Trauma Center. Participants Patients with SCI admitted to acute inpatient rehabilitation (N = 282). Main Outcome Measures VTE prevalence in patients with LVitD levels, grouped by presence or absence of vitamin D supplementation. Results Of the acute inpatient SCI population, 80% (227/282) of patients demonstrated vitamin D levels <30 ng/mL (LVitD). Although the incidence of VTE was almost double in the LVitD group, 19% (43/227) of the patients in the LVitD group had VTE versus 9% (5/55) of patients with vitamin D levels ≥30 ng/mL (normal VitD [NVitD]); this difference was not statistically significant ( P = .108, Cramer's V = .104). When the role of vitamin D supplementation was analyzed, individuals in the LVitD group who received no vitamin D supplementation (LVitDSuppNegative) had a higher incidence of VTE (statistically significant) compared to the LVitD group with vitamin D supplementation (LVitDSuppPositive) (24% [42/178] vs. 2% [1/49]) ( P < .001, Cramer's V = .226). In post hoc exploratory analyses, the VTE rate of patients in the LVitDSuppNegative group was noted to be significantly higher than that in all other patient groups combined ( P < .001, Cramer's V = .229). A binary logistic regression model incorporating clinical covariates also showed this grouping to be significant. Conclusion A significant association appears to exist between lack of vitamin D supplementation and VTE occurrence in persons with acute SCI and LVitD levels. Level of Evidence III