Prevalence and association of vitamin D deficiency and mortality in patients with severe sepsis

Abstract

BackgroundVitamin D is a steroid prohormone that regulates body calcium and phosphate metabolism. Recent studies have shown an association between low vitamin D status and high mortality in patients admitted to intensive care units. To date, there are limited data available specifically about severely septic patients in medical units.ObjectivesTo determine the prevalence of vitamin D deficiency in severely septic patients and its clinical outcomes, including mortality rate.MethodsA prospective observational study was conducted to investigate the prevalence of vitamin D deficiency and its association with 30-day mortality in patients with severe sepsis. Patients admitted to medical wards at our hospital between November 2014 and March 2015 were included in the study. A 25-hydroxyvitamin D level <20 ng/mL was defined as vitamin D deficiency, and <12 ng/mL as severe deficiency. For an association analysis, the patients were grouped into deficient versus not deficient and severely deficient versus not severely deficient.ResultsOne hundred and ten eligible patients were enrolled. A total of 83 patients (75%) had vitamin D deficiency and 42 (38%) had severe deficiency. Despite an insignificant higher 30-day hospital mortality rate in vitamin D deficient versus non-deficient groups (16% vs 4%, p=0.18), the differences were significant between the severely deficient versus non-severe groups (23% vs 4%, p=0.02). The odds ratio of the 30-day mortality rate was 4.83 (95% confidence interval [CI], 0.60–38.77, p=0.14) for vitamin D deficiency and 7.69 (95% CI, 2.00–29.55, p=0.003) for severe deficiency.ConclusionThe prevalence of vitamin D deficiency was very high in three-quarters of patients with severe sepsis. A significant higher mortality rate was observed, particularly in patients with severe vitamin D deficiency.

Vitamin D deficiency – a potential risk factor for sepsis development, correlation with inflammatory markers, SOFA score and higher early mortality risk in sepsis

“…The signifi cantly lower levels of 25(OH)D ranking in severe VD defi ciency range in the group of patients, who did not survive the 7th day of hospital care compared to those, who survived the 7th day after admission to ICU (p = 0.0076), point out the potential impact of VD level on early mortality risk in patients with systemic infl ammatory response syndrome of both SIRS and sepsis. This fi nding consents with the results of other authors who declare, that VD defi ciency at the time of critical care initiation is a signifi cant predictor of overall cause patient mortality in a critically ill patient population, independently of other comorbidities (59,62). This also correspond with our signifi cant correlation with SOFA score, but non-signifi cant correlation with APACHE II -a scoring system of clinical condition of patients, that takes into account also other comorbidities, not only acute state.…”

“…The mean level of 25(OH)D (12.831 ± 6.642 μg/L) in the examined cohort of 32 adult patients admitted to the ICU because of systemic infl ammatory response syndrome of both infectious and non-infectious origin is deeply below the normal range of 25(OH)D level (> 30 μg/L) (37,39,40). It is even approaching the boundary of severe vitamin D defi ciency (25(OH)D level < 12 μg/L) (58,59).…”

<p>Association of Serum Levels of Vitamin D with Blood Pressure Status in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS)</p>

“…5,6 Evidence demonstrates that vitamin D may regulate blood pressure by direct vascular effect via vitamin D receptors on endothelial cells, 7 and regulating the renin-angiotensin system via effects on the juxtaglomerular apparatus. 8,9 Most observational studies found that low serum vitamin D levels are associated with the risk of hypertension, 10 and with higher rates of cardiovascular events 11 and increased mortality rates, 12,13 but this relationship disappeared after adjustment for confounding factors in some studies. 14 Although interventional studies have suggested that vitamin D supplementation may reduce mortality, 15 recent systematic reviews and meta-analysis on the effects of vitamin D supplementation on blood pressure reduction found weak evidence to support a small blood pressure lowering effects of vitamin D and thus advised against using as an antihypertensive agent.…”

The significance of the vitamin D metabolism in the development of periprosthetic infections after THA and TKA: a prospective matched-pair analysis of 240 patients

“…This phenomenon confirms the data of Maier et al 6 This compound is also described in the studies on sepsis. 4 Therefore, it must be assumed that no distinction between acute and chronic infections has been made in the two described studies, which in turn could explain the different results. In a retrospective analysis, the distinction between acute and chronic infections seems more important than the distinction between PPI in general and primary implantation or replacement surgery.…”

“…Hence, in this study, patients with massive vitamin D deficiency showed a significantly higher mortality rate. 4 Tiwari et al proved with his investigation that a strong vitamin D deficiency is associated with increased cytokine concentrations in diabetics, which had a negative impact especially on those with a foot infection. 5 However, despite these works, the role of vitamin D in periprosthetic infections (PPIs) is largely unexplored.…”