Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Abstract

Background Vitamin D has immunomodulating properties. Objective To determine if vitamin D deficiency within 30 days of admission to the intensive care unit in patients with sepsis might be associated with increased all-cause 30-day mortality. Methods In a retrospective cohort study at a large, tertiary, urban, academic medical center, records of patients who had 25-hydroxyvitamin D levels measured within 30 days of admission for severe sepsis or septic shock from June 2006 to April 2011 were examined. Patients were considered deficient in vitamin D if its serum concentration was 15 ng/mL or less. The primary outcome of interest was 30-day mortality. Results Among the 121 patients in the sample, 65 (54%) were vitamin D deficient. Baseline demographics were similar between vitamin D deficient and nondeficient groups, except that the vitamin D deficient group had more African Americans (P = .01). All-cause 30-day mortality was significantly higher in patients deficient in vitamin D (37% vs 20%; P = .04) and remained higher at 90 days (51% vs 25%, P = .005). In multivariate analysis, age (odds ratio, 1.04; 95% CI 1.01–1.07; P = .01) and vitamin D deficiency (odds ratio, 2.7; 95% CI, 1.39–18.8; P = .02) were independently associated with increased 30-day mortality. Conclusion Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.

Outcomes of Vitamin D Supplementation in Adults Who are Deficient and Critically Ill: A Review of the Literature

“…8 33; P , 0.0001 for adjusted group), which remained significant after adjusting for confounders, such as age, gender, race, Deyo-Charlson index, season, unit type, and sepsis. 19 When vitamin D levels were checked closer to the time of critical care initiation, there was a similar correlation with mortality.…”

“…Those who reported taking vitamin D 2 or D 3 supplementation before admission (dose not specified) were found to have lower hospital mortality (P 5 0.01) and 90-day mortality (P 5 0.02) compared with those who did not take vitamin D supplements. 8 Although many large 37 and small studies 9 have been able to detect an association between vitamin D levels and mortality, there are some studies where this association has not been observed. 22,24,38,39,46 Observational studies reporting associations between vitamin D deficiency on mortality outcomes in critically ill patients are summarized in Table 2.…”

“…6 Other Vitamin D in Illness studies support the association between sepsis and vitamin D deficiency. 8,43 Infection Despite theoretical involvement of adequate vitamin D on immunocompetence, there have been few studies showing strong associations between deficient vitamin D levels and relative risk of specific infection. Retrospective and prospective observational studies have not been able to show an association between low vitamin D levels and blood culture positivity (measured by leukocyte count and procalcitonin levels), 37 infection rate, 22 nor pneumonia rates.…”

“…1 In recent years, a body of evidence has evolved implicating vitamin D in other processes such as immunity, infection, 2 antiproliferation, 3 muscle strength, 4 and clinical outcomes, such as sepsis, 5,6 mortality, 7,8 and respiratory health. 9 There is a high prevalence of vitamin D deficiency reported in critically ill patients ranging from 17% 6 to 82%.…”

Recent Advances in Multidisciplinary Critical Care

“…Furthermore, shortages in nutritional elements such as vitamin d, known to have immunomodulating properties, are also associated with higher mortality in patients with sepsis or critically ill patients in general. 47,48 In order to minimize the chance of caloric deficits, nutrition support protocols have been developed. Careful implementation of such a protocol shortens time to achieve feeding goals.…”