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Vitamin D may be simple way to ‘enhance’ burn healing

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Vitamin D may be a simple treatment to enhance burn healing, according to UK researchers.

Patients with severe burns who have higher levels of vitamin D recover more successfully than those with lower levels, according to a study presented a conference this week.

“Adding this vitamin back may be a simple, safe and cost-effective way to improve outcomes for burns patients”

Janet Lord

The study represents the first to investigate the role of vitamin D in recovery from burn injury and suggests that supplementation may be a simple and cost-effective treatment to enhance burn healing.

Despite improvements in burn care over the last 10 years, many patients are still at risk of poor recovery, noted the researchers at the Society for Endocrinology annual conference in Harrogate.

Complications can range from delayed wound healing through to infections, with patients with severe burns are at high risk of infection that may lead to life-threatening sepsis, they warned.

They also highlighted that vitamin D was known to have antibacterial actions that may help combat infection and therefore aid in wound healing of burn patients.

To investigate its potential role in recovery from burn injuries, the researchers assessed the recovery progress, over one year, in patients with severe burns and correlated it with their vitamin D levels.

The study found that patients with higher levels of vitamin D had a better prognosis, with improved wound healing, fewer complications and less scarring.

The data also showed that burns patients tend to have lower levels of vitamin D, said the researchers from the Institute of Inflammation and Aging in Birmingham.

These data suggest that vitamin D supplementation immediately following burn injury may have potent health benefits to the patient, including enhanced antimicrobial activity to prevent infection, and improved wound healing.

“Vitamin D levels are something generally overlooked by clinicians”

Janet Lord

Senior study author Professor Janet Lord said: “Major burn injury severely reduces vitamin D levels and adding this vitamin back may be a simple, safe and cost-effective way to improve outcomes for burns patients, with minimal cost to NHS.”

The effectiveness of vitamin D supplementation to improve outcomes in burn patients would need to be verified in clinical trials, noted the researchers.

Professor Lord and her team are now focussed on finding out why there is a rapid loss of vitamin D in patients immediately following burn injury and hope they may be able to prevent this in future.

They noted that the amount of reduction in patients’ vitamin D levels was not related to the severity of the burn, so levels may also be decreased in more minor burn injuries.

Professor Lord said: “Low vitamin D levels were associated with worse outcomes in burn patients including life threatening infections, mortality and delayed wound healing.

“It was also associated with worse scarring, but vitamin D levels are something generally overlooked by clinicians,” she added.

Abstract: Influence of Vitamin D on Outcomes Following Burn Injury: An Observational Cohort Study

Khaled Al-Tarrah1,2, Carl Jenkinson3, Martin Hewison3, Naiem Moiemen2, Janet Lord1

1Institute of Inflammation & Aging, Birmingham, United Kingdom, 2Scar Free Foundation Burns Research Centre, Birmingham, United Kingdom, 3Institute of Metabolism & Systems Research, Birmingham, United Kingdom

Introduction: Low levels of vitamin D are associated with higher mortality in critically ill patients. Studies on vitamin D levels in adult burn patients and their influence on clinical outcomes are scarce. Therefore, vitamin D status following thermal injury is often overlooked as its clinical implications are poorly understood.

Aim: To examine the relationship of major thermal injury on the vitamin D axis and the influence of vitamin D levels on outcomes in adult burn patients.

Methods: An observational cohort study in major burn injury patients (TBSA ≥20%) with patients followed up for 1 year following injury and blood samples taken at 10 time-points. Vitamin D metabolites and their serum carrier vitamin D binding protein (DBP) were assessed using LC-MS/MS and ELISA respectively. Various clinical outcomes of patients were recorded, including wound healing, sepsis, multiorgan failure and mortality.

Results: 38 burn patients with median TBSA of 42% were assessed. The inactive circulating form of vitamin D, 25-hydroxyvitamin D3 (25D3) and DBP were significantly reduced following major burn injury compared with healthy controls. Median 25D3 remained low.

Conclusion: Thermal injury affects vitamin D status, with low 25D3 levels predisposing patients to poorer prognosis. Data indicate that low serum 25D3 impairs tissue-specific antibacterial and wound healing responses in burn patients, potentially via tissue-specific activation and function. Supplementing with high doses of vitamin D to increase serum 25D3 may greatly improve health outcomes in burns patients.

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