Delta-Procalcitonin and Vitamin D Can Predict Mortality of Internal Medicine Patients with Microbiological Identified Sepsis

Abstract

Background: The management of septic patients hospitalized in Internal Medicine wards represents a challenge due to their complexity and heterogeneity, and a high mortality rate. Among the available prognostic tools, procalcitonin (PCT) is considered a marker of bacterial infection. Furthermore, an association between vitamin D deficiency and poor sepsis-related outcomes has been described. Objectives: To evaluate the prognostic accuracy of two consecutive PCT determinations (Delta-PCT) and of vitamin D levels in predicting mortality in a population of patients with microbiological identified sepsis admitted to Internal Medicine wards. Methods: This is a sub-analysis of a previous prospective study. A total of 80 patients had at least two available consecutive PCT determinations, while 63 had also vitamin D. Delta-PCT was defined as a reduction of PCT > 50% after 48 h, >75% after 72 h, and >85% after 96 h. Mortality rate at 28- and 90-days were considered as main outcome. Results: Mortality rate was 18.7% at 28-days and 30.0% at 90-days. Baseline PCT levels did not differ between survived and deceased patients (28-days: p = 0.525; 90-days: p = 0.088). A significantly higher proportion of survived patients showed Delta-PCT (28-days: p = 0.002; 90-days: p < 0.001). Delta-PCT was associated with a lower 28-days (p = 0.007; OR = 0.12, 95%CI 0.02–0.46) and 90-days mortality (p = 0.001; OR = 0.17, 95%CI 0.06–0.48). A significantly higher proportion of deceased patients showed severe vitamin D deficiency (28-days: p = 0.047; 90-days: p = 0.049). Severe vitamin D deficiency was associated with a higher 28-days (p = 0.058; OR = 3.95, 95%CI 1.04–19.43) and 90-days mortality (p = 0.054; OR = 2.94, 95%CI 1.00–9.23). Conclusions: Delta-PCT and vitamin D represent two useful tests for predicting prognosis of septic patients admitted to Internal Medicine wards.

Physiological Basis for Using Vitamin D to Improve Health

“…Those affected are particularly vulnerable to viral respiratory illnesses such as seasonal flu, influenza, respiratory syncytial virus, and COVID-19. Worldwide, sepsis is responsible for approximately seven million annual deaths: a major contributory factor for this is vitamin D deficiency [ 164 ]; half of these premature deaths could have been prevented by taking proactive actions to treat them aggressively with vitamin D and calcifediol as described in this article. The goal is to rapidly raise serum 25(OH)D concentration above 50 ng/mL, allowing it to boost the immune system [ 20 ].…”

Ex Vivo Evaluation of the Sepsis Triple Therapy High-Dose Vitamin C in Combination with Vitamin B1 and Hydrocortisone in a Human Peripheral Blood Mononuclear Cells (PBMCs) Model

“…The management of septic patients is a serious challenge due to syndrome complexity and heterogeneity. Since vitamin B1 did not affect LPS-induced cytokine secretion, a rationale can be established to modify Marik’s protocol [ 33 ], eliminating vitamin B1 and replacing it, for example, with vitamin D. Severe vitamin D deficiency was described to be independently associated with increased mortality in adult patients with sepsis [ 67 , 68 ]. Therefore, the determination of procalcitonin and vitamin D were recommended for prediction of septic prognosis in patients [ 68 ].…”

“…Since vitamin B1 did not affect LPS-induced cytokine secretion, a rationale can be established to modify Marik’s protocol [ 33 ], eliminating vitamin B1 and replacing it, for example, with vitamin D. Severe vitamin D deficiency was described to be independently associated with increased mortality in adult patients with sepsis [ 67 , 68 ]. Therefore, the determination of procalcitonin and vitamin D were recommended for prediction of septic prognosis in patients [ 68 ]. An adjuvant vitamin D therapy improved a sepsis score and diminished the incidence of septic shock in neonates and children [ 69 , 70 ].…”

Sepsis: New Challenges and Future Perspectives for an Evolving Disease—Precision Medicine Is the Way!

“…Our research group focused on the prognostic accuracy of delta-PCT (a reduction of PCT > 50% after 48 h, >75% after 72 h, and >85% after 96 h) in predicting mortality of Internal Medicine patients with microbiological identified sepsis [15]. In a sample of 80 patients with at least two available PCT determinations, those patients with Delta-PCT showed a significantly higher proportion of survival both at 28-days and 90-days.…”