Introduction: Vitamin D, a neurosteroid present in cerebrospinal fluid and metabolized by brain tissue regulates calcium signaling and scavenging of reactive oxygen species, which play a role in acute cell injury after ischemic stroke and intracerebral hemorrhage (ICH). Low vitamin D (measured as 25(OH)D), has been found to increase the risk of ischemic stroke, predict severity and poor functional outcome. No studies investigating impact of vitamin D level on ICH stroke severity exist.
Hypothesis: We hypothesize that low 25(OH)D levels are associated with higher stroke severity of ICH on admission and poorer functional outcome.
Methods: A single-center retrospective chart review between February 2012 and September 2014 was performed. A total of 109 patients with primary ICH and 25(OH)D levels on admission were identified. Serum 25(OH)D levels were dichotomized at <30 ng/ml as Vitamin D deficient and <10 ng/ml as severely deficient. Dichotomized 25(OH)D groups were compared for continuous outcome variables using non-parametric Wilcoxon rank-sum test. Severity measures including dichotomized NIHSS (>20 or <20) and dichotomized Glasgow coma scale (GCS of 3-5, 6-15) were compared to vitamin D groups using Pearson Chi-square test of proportion.
Results: NIHSS on admission was higher in patients with severe vitamin D deficiency (p=0.016) with the odds ratio of having an NIHSS of >20 on admission 5.9 (95% CI --1.4-25.5). Patients with severe deficiency were far more likely to have very low GCS (3-5) (p=0.022; OR=8.8; 95% CI 1.7 - 45.5). Vitamin D deficiency was associated with lower pre-albumin level and older age (p=0.021 and 0.018, respectively). No statistical significance between 25(OH)D level and ICH score, ICH volume, location, presence of intraventricular hemorrhage, length of stay, mortality, disposition or pre-stroke and discharge modified Rankin Scale was found.
Conclusions: ICH patients with severe vitamin D deficiency had significantly worse stroke severity. Patients with older age and malnutrition are at higher risk for severe clinical presentation of ICH. Larger scale studies identifying increased risk of morbidity and mortality from ICH in vitamin D deficient patients are needed.