Vitamin D status is associated with hepcidin and hemoglobin concentrations in patients with severe traumatic injury.

Abstract

BACKGROUND:

Severe traumatic injury leads to persistent injury-associated anemia that is associated with hypercatecholaminemia, systemic inflammation, increased hepcidin, and a functional iron deficiency. Vitamin D has been shown to reduce proinflammatory cytokines and hepcidin concentrations. This study aimed to investigate the association of vitamin D status with inflammation, iron biomarkers, and anemia following blunt trauma.

METHODS:

A prospective observational cohort study comparing blunt trauma patients (n = 45) with elective hip replacement patients (n = 22) and healthy controls (n = 8) was performed. Bone marrow ferroportin, transferrin receptor, and erythroferrone expression was measured using quantitative polymerase chain reaction (qPCR). Plasma was assessed for systemic inflammation, erythropoietin (EPO), iron regulation, and vitamin D (25-OH) concentrations using enzyme-linked immunosorbent assay. Hemoglobin was measured on the day of discharge.

RESULTS:

Compared with hip replacement, trauma patients had higher plasma interleukin-6 (90.1 vs. 3.8 pg/mL), C-reactive protein (6,223 vs. 2,612 ng/mL), and hepcidin (79.3 vs. 21.2 ng/mL) concentrations. Trauma patients had lower vitamin D (25-OH) (12.8 vs. 18.1 ng/mL) and iron (23.5 vs. 59.9 μg/mL) levels compared with hip replacement patients. Despite the higher hepcidin EPO levels, bone marrow erythroferrone expression was increased 69% following trauma.

CONCLUSION:

Following elective hip replacement, patients did have anemia and impaired iron homeostasis without a significant change in inflammatory biomarkers, EPO, and vitamin D status. Vitamin D status did correlate with systemic inflammation, iron dysfunction, and persistent injury-associated anemia following severe blunt trauma. Further research is needed to determine whether supplementation with vitamin D in the trauma population could improve the persistent injury-associated anemia.

LEVEL OF EVIDENCE:

Prospective study, prognostic, level III.

• Authors: Camille G Apple, Elizabeth S Miller, Kolenkode B Kannan, Julie A Stortz, Michael Cox, Tyler J Loftus, Hari K Parvataneni, Matthew Patrick, Jennifer E Hagen, Scott Brakenridge, Philip A Efron, Alicia M Mohr
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 89 Issue 6 Pg. 1124-1130 (12 2020) ISSN: 2163-0763 [Electronic] United States
• PMID: 32769953 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural)

Chemical References

• Biomarkers
• EPO protein, human
• Hemoglobins
• Hepcidins
• Erythropoietin
• Vitamin D
• C-Reactive Protein
• Iron

Topics

• Adult
• Anemia, Iron-Deficiency (etiology)
• Biomarkers (blood)
• C-Reactive Protein (analysis)
• Erythropoietin (blood)
• Female
• Hemoglobins (analysis)
• Hepcidins (blood)
• Humans
• Iron (blood)
• Male
• Middle Aged
• Prospective Studies
• Vitamin D (blood)
• Vitamin D Deficiency (etiology)
• Wounds, Nonpenetrating (blood, complications)