Vitamin D supplementation may be beneficial in improving the prognosis of patients with sepsis-associated acute kidney injury in the intensive care unit: a retrospective study
Front Med (Lausanne). 2024 Dec 2:11:1453522. doi: 10.3389/fmed.2024.1453522
Jie Sun 1, Yan Wang 2, Jue Wang 1, Hongwei Wu 1, Zhefeng Xu 1, Dongsheng Niu 1
Background: Vitamin D, an essential fat-soluble micronutrient, exerts diverse physiological effects including the regulation of calcium ion homeostasis, modulation of immune response, and enhancement of resistance against infectious pathogens. Empirical investigations have elucidated an association between inadequate levels of vitamin D and adverse clinical outcomes in critically ill cohorts, with a noteworthy prevalence of vitamin D deficiency observed among patients afflicted with acute kidney injury (AKI). In the context of this retrospective inquiry, our aim was to assess the potential correlation between vitamin D supplementation administered during admission to the intensive care unit (ICU) and the improvement of outcomes specifically in cases of severe AKI.
Methods: This study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV), a repository of ICU patient records from Beth Israel Deaconess Medical Center (BIDMC) in the United States. We focused on patients diagnosed with epsis-associated acute kidney injury (SA-AKI), dividing them into those who received vitamin D supplementation during their ICU admission and those who did not. Our primary analysis evaluated in-hospital mortality using various statistical methods, such as Kaplan-Meier survival curves, Cox proportional hazards regression models, and subgroup analyses. To enhance the robustness of our findings, we used propensity score matching (PSM) to reduce potential biases. Secondary outcomes included 28-day, 90-day mortality rates and norepinephrine-free days at 28 days.
Results: In this investigation, a cohort of 11,896 individuals diagnosed with SA-AKI was studied. Among them, 2,724 patients received vitamin D supplementation (the vitamin D group) while 9,172 did not (the no-vitamin D group). Kaplan-Meier survival analysis indicated a significant difference in survival probabilities between the two cohorts. Upon adjusting for potential confounders using Cox regression modeling, a notably decreased risk of hospitalization and ICU mortality was observed in the vitamin D group compared to the no-vitamin D group, with an adjusted risk ratio for in-hospital mortality of 0.56 (95% CI: 0.5-0.63). These findings were consistent following PSM and subsequent adjustments for propensity score, pairwise algorithm (PA), and overlapping weights (OW) analyses, yielding hazard ratios ranging from 0.53 to 0.59, all with p-values <0.001. Notably, E-value analyses underscored the robustness of these results against potential unmeasured confounders.
Conclusion: This study suggests that vitamin D supplementation may be associated with a reduced in-hospital mortality rate among SA-AKI patients in the ICU. Furthermore, the 28-day, 90-day mortality rates and norepinephrine days were significantly reduced in the group receiving vitamin D supplementation.
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VitaminDWiki – Sepsis is both prevented and treated by Vitamin D - many studies contains:
- Sepsis is more likely in those with poor immune systems
Infants, the elderly, the sick, and those with low vitamin D - Severe sepsis has been associated with low Vitamin D and poor Vitamin D receptor in many studies
- Loading doses of Vitamin D bypass any poor Vitamin D Receptors
- Vitamin D loading doses have been proven to treat sepsis (RCTs: 2015, 2020, 2021)
Reduced: ICU stay by 8 days, Hospital stay by 7 days, and readmission rate reduced to 0%
Note: The fastest way (2 hours) to have a sublingual loading dose of Vitamin D nano-emulsion - Sepsis is fought by Vitamin D in 9 ways – Feb 2023