Clinical and microbiological outcome in septic patients with extremely low 25-hydroxyvitamin D levels at initiation of critical care.
Clin Microbiol Infect. 2015 Dec 22;
Authors: De Pascale G, Vallecoccia MS, Schiattarella A, Di Gravio V, Cutuli SL, Bello G, Montini L, Pennisi MA, Spanu T, Zuppi C, Quraishi SA, Antonelli M
A relationship between vitamin D (VD) status and mortality in Intensive Care Unit (ICU) patients has been recently documented. Aim of the present study was to describe the clinical profile and sepsis-related outcome of critically ill septic patients with extremely low (<7 ng/mL) VD levels at ICU admission. We conducted an observational study in the ICU of a teaching hospital including all patients admitted with severe sepsis/septic shock and undergoing 25-hydroxyvitamin D (25(OH)D) testing within the first 24 hours from admission. We studied 107 patients over 12 months. At ICU admission VD deficiency (≤20ng/mL) was observed in 93.5% of the patients: 57 (53.3%) showed levels < 7ng/mL. As primary outcome, sepsis-related mortality rate was higher in patients with VD levels < 7ng/mL (50.9% vs 26%). Multivariate regression analysis showed that VD concentration < 7 ng/mL on ICU admission (p=0.01) and higher mean SAPS II (p<0.01) score were independent predictors of sepsis-related mortality. Patients with very low VD levels suffered higher rate of microbiologically confirmed infections but a lower percentage of microbiological eradication respect to patients whose values were above 7 ng/mL (80.7% vs 58%, p=0.02; 35.3% vs 68%; p=0.03, respectively). Post-hoc analysis showed that, in the extremely low VD group, the 52 patients with pneumonia showed a longer duration of mechanical ventilation (9 days [3.75-12.5] vs. 4 days [2-9], p=0.04) and the 66 with septic shock needed vasopressor support for a longer period of time (7 days [4-10] vs. 4 days [2-7.25], p=0.02). Sepsis-related mortality rate was higher in patients with VD levels <7ng/mL (50.9% vs 26%). Multivariate regression analysis showed that VD concentration <7 ng/mL on ICU admission (p=0.01) and higher mean SAPS II (p<0.01) score were independent predictors of sepsis-related mortality. Our results suggest that in critical septic patients extremely low VD levels on admission may be a major determinant of clinical outcome. Benefits of VD replacement therapy in this population should be elucidated.
PMID: 26721785 [PubMed - as supplied by publisher]