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Low vitamin D levels linked to mortality risk for patients with sepsis
In patients with sepsis, a lower blood level of 25-hydroxyvitamin D at ICU admission is an independent risk factor for 28-day mortality, particularly among parathyroid hormone responders, according to recent findings.
Moreover, serum 25-(OH)D concentration appears to be inversely associated with procalcitonin (PCT) levels, and the association between lower 25-(OH)D levels and increased mortality is greater when seen in parathyroid hormone (PTH) responders than in nonresponders, according to the researchers.
In the prospective, observational study, researchers evaluated 236 septic patients who presented to a medical or surgical ICU or the First Affiliated Hospital of Guangxi Medical University in Nanning, China. The researchers collected the following baseline data from all participants upon ICU admission: demographic information, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score and the results of hematologic and biochemical tests.
Blood samples were tested for 25-(OH)D, PCT, intact PTH, albumin, creatinine and ionized calcium levels. The researchers also documented the season in which 25-(OH)D levels were measured, fluid load before 25-(OH)D sampling, duration of mechanical ventilation and ICU length of stay. Seventy-five of the patients were 25-(OH)D deficient, 100 were insufficient and 61 were sufficient.
The researchers found that patients with 25-(OH)D deficiency had significantly higher APACHE II scores (P<.001), SOFA scores (P<.001), positive blood culture rates (P=.01), PCT levels (P<.001), intact PTH levels (P<.001), and 28-day mortality (P<.001), but lower ionized calcium levels (P=.012), compared with those who were 25-(OH)D sufficient or insufficient. Longer ICU length of stay and time on ventilator (P<.001) were found among patients with 25-(OH)D deficiency vs. those who were sufficient or insufficient.
No variation was found among the three categories of vitamin D status in terms of age, gender, 25-(OH)D sampling seasonality, serum albumin, serum creatinine and fluid load.
A significant negative linear correlation was found between 25-(OH)D levels and PCT levels (P<.001).
Compared with PTH nonresponders, PTH responders had a higher 28-day mortality rate (P=.021) and lower ionized calcium levels (P=.001) and 25-(OH)D levels (P<.001).
According to the researchers, additional studies are needed to further investigate these associations.
“Given that supplementation to prevent vitamin D deficiency is simple and inexpensive, further research is merited to examine whether correction of vitamin D deficiency by vitamin D supplementation improves clinical outcomes and decreases PCT levels in septic patients in the ICU,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.