Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill.
Crit Care Med. 2014 Jan;42(1):97-107. doi: 10.1097/CCM.0b013e31829eb7af.
Moromizato T, Litonjua AA, Braun AB, Gibbons FK, Giovannucci E, Christopher KB.
OBJECTIVE: We hypothesized that deficiency in 25-hydroxyvitamin D prior to hospital admission would be associated with sepsis in the critically ill.
DESIGN: Two-center observational study of patients treated in medical and surgical ICUs.
SETTING: Two hundred nine medical and surgical intensive care beds in two teaching hospitals in Boston, MA.
PATIENTS: Three thousand three hundred eighty-six patients, 18 years old or older, in whom 25-hydroxyvitamin D was measured prior to hospitalization between 1998 and 2011.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: : Preadmission 25-hydroxyvitamin D was categorized as deficiency in 25-hydroxyvitamin D (≤ 15 ng/mL), insufficiency (15-30 ng/mL), and sufficiency (≥ 30 ng/mL). The primary outcome was sepsis as defined by International Classification of Diseases, 9th Edition, Clinical Modification and validated by the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine, American College of Chest Physicians, American Thoracic Society, and Surgical Infection Society international sepsis definitions conference guidelines. Logistic regression examined the presence of sepsis 3 days prior to critical care initiation to 7 days after critical care initiation. Adjusted odds ratios were estimated by multivariable logistic regression models. Preadmission 25-hydroxyvitamin D deficiency is predictive for the risk of sepsis. In the full cohort, 25-hydroxyvitamin D deficiency is a significant predictor for the risk of International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Deyo-Charlson index (adjusted odds ratio, 1.51 [95% CI, 1.17-1.94]; p = 0.001) relative to patients with 25-hydroxyvitamin D sufficiency. In a subset of cohort patients enriched for those with International Classification of Diseases, 9th Edition, Clinical Modification-diagnosed sepsis (n = 444), preadmission 25-hydroxyvitamin D deficiency is a significant predictor for the risk of conference guideline-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Acute Physiology and Chronic Health Evaluation II (adjusted odds ratio, 2.05 [95% CI, 1.19-3.52]; p = 0.009) relative to patients with 25-hydroxyvitamin D sufficiency.
Furthermore, in cohort patients with International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis (n = 568), the multivariable adjusted risk of 90-day mortality was 1.6-fold higher in those with preadmission 25-hydroxyvitamin D values in the insufficient and deficient range, compared with those with preadmission vitamin D sufficiency (adjusted odds ratio, 1.63 [95% CI, 1.11-2.39]; p = 0.01).
CONCLUSION: 25-hydroxyvitamin D deficiency prior to hospital admission is a significant predictor of sepsis in the critically ill. Additionally, patients with sepsis who are not vitamin D sufficient have an increased risk of mortality following critical care initiation.
PMID: 23982028
See also VitaminDWiki
- Sepsis is both prevented and treated by Vitamin D - many studies
- Sepsis associated with low vitamin D - April 2012
- Hospital or ICU death about twice as likely if low vitamin D – March 2014
- Google Search for SEPSIS at VitaminDWiki 128 items as of Feb 2014
See also web
- Sepsis a explicit or implicit factor in one out of 2 or 3 hospital deaths Medscape June 2014
no mention of vitamin D. All patients appeared to have sepsis at hospital admission. studied 7,000,000 hospital admissions.
PDF attached at the bottom of this page - Is vitamin D supplementation a new hope for the therapy of the septic shock? 2013