Blackwell, S.

Kinsella, J.

Knox, S.

McMillan, D.

O'Reilly, D.S.J.

Reid, D.

Talwar, D.

Wallace, A.M.

English

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       Reid, D. and Knox, S. and Talwar, D. and O'Reilly, D.S.J. and Blackwell, S. and Kinsella, J. and McMillan, D. and Wallace, A.M. (2010) Acute changes in the systemic inflammatory response are associated with transient decreases in circulating 25-hydroxyvitamin D concentrations following elective knee arthroplasty [POSTER]. In: Focus: Association for Clinical Biochemisrty National Meeting, 11-13 May 2010, Glasgow, UK.  http://eprints.gla.ac.uk/29889/  Deposited on: 31 May 2010   Enlighten – Research publications by members of the University of Glasgow http://eprints.gla.ac.uk Acute changes in the systemic inflammatory response are associated with transient decreases in circulating 25-hydroxyvitamin D concentrations following elective knee arthroplasty.D Reid1, S Knox2, D Talwar2, DSJ O' Reilly2, S Blackwell2, J Kinsella1, D McMillan3, AM Wallace2Glasgow Royal Infirmary, University Dept of Anaesthesia, Glasgow G31 2ER, United Kingdom,1 Glasgow Royal Infirmary, Clinical Biochemistry, Glasgow, United Kingdom,2 Glasgow Royal Infirmary, University Dept of Surgery, Glasgow, United Kingdom,3IntroductionThere is increasing awareness that vitamin D is more than just a fat-soluble vitamin that regulates calcium metabolism. Vitamin D deficiency has recently been associated with numerous diseases including cancer and cardiovascular disease and has apparent anti-inflammatory and anti-proliferative properties.1,2, Vitamin D deficiency has also been associated with mortality in intensive care.3 There is, however, good evidence that plasma concentrations of other fat soluble vitamins fall following an inflammatory insult.4 In the current study we investigated whether plasma 25-hydroxyvitamin D (25-OHD) concentrations were altered during the evolution of the systemic inflammatory response in patients following elective knee arthroplasty.Methods34 patients who underwent elective knee arthroplasty and had no evidence of a systemic inflammatory response were recruited in to the study. Venous blood samples were withdrawn before surgery and post-operatively at 6 and 12 hours and each morning for the next 5 days. Albumin and C-reactive protein were measured on an Adiva 1650 analyser (Bayer Corporation, Tarrytoen, NY USA). Measurement of plasma 25-OHD incorporated an automated solid-phase extraction (SPE) procedure followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS).5 The lower limit of sensitivity was 4nmol/L . Within- and between-assay precision was below 10% over the concentration range of 22.5-120nmol/L . Comparisons of data from different time periods were carried out using a non- parametric ANOVA (Friedman test, SPSS software). ResultsThe median 25-OHD concentration fell significantly within 6 hours and remained low for the following 5 days. The results are shown in table 1 and figure 1. Over the same time period there was a significant increase in the median plasma CRP concentrations (169 mg/l at 48hrs,  p<0.001) and a significant fall in the median albumin concentrations (31 g/l at 48hrs, p< 0.001). CRP remained significantly elevated at 100mg/l on day 5. ConclusionsThe results of the present study indicate, that in apparently healthy subjects undergoing an acute inflammatory insult, plasma 25-OHD concentrations are reduced, by approximately 30%, during the evolution of the systemic inflammatory response. Plasma concentrations of 25-OHD are therefore unlikely to be a reliable indicator of vitamin D status in patients exhibiting a systemic inflammatory response.References1. Lee JH, O’Keefe JH et al Vitamin D Deficiency. J Am Col Cardiol 2008: 52: 1949-19562. Melamed ML, Michos ED et al. 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population. Arch Intern Med 2008: 168: 1629-16373. Lee P, Eisman JA et al. Vitamin D Deficiency in Critically Ill Patients. NEJM 2009: 360: 1912-19134. Gray A, McMillan DC et al. The relationship between the acute changes in the systemic inflammatory response, lipid soluble anti-oxidant vitamins and lipid peroxidation following elective knee arthroplasty. Clin Nutr 2005: 24: 746-7505. Knox S, Harris J et al. A simplified solid-phase extraction procedure for measurement of 25-hydroxyvitamin D3 and D2 by liquid chromatography-tandem mass spectrometry. Ann Clin Biochem 2009: 46:226-230Figure 1: Box plot of 25-OHD concentrations at eachsampling time pointSample time25-OHD (nmol/l)Sample time Median 25-OHD   (nmol/l)P value(ANOVA)Pre-operative 376 hours 26 <0.00112 hours 24 <0.001Day 1 26 <0.001Day 2 28 <0.001Day 3 25 <0.001Day 4 27 <0.001Day 5 28 <0.001Table 1

A simplified solid-phase extraction procedure for measurement of 25-hydroxyvitamin D3 and D2 by liquid chromatography-tandem mass spectrometry. Ann Clin Biochem

O’Keefe JH et al Vitamin D Deficiency.

The relationship between the acute changes in the systemic inflammatory response, lipid soluble anti-oxidant vitamins and lipid peroxidation following elective knee arthroplasty. Clin Nutr

Acute changes in the systemic inflammatory response are associated with transient decreases in circulating 25-hydroxyvitamin D concentrations following elective knee arthroplasty [POSTER]

http://eprints.gla.ac.uk/29889/1/29889.pdf

Acute changes in the systemic inflammatory response are associated with transient decreases in circulating 25-hydroxyvitamin D concentrations following elective knee arthroplasty [POSTER]

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