Vitamin D is an important immune modulator and is associated with susceptibility to infection. However, past studies have reported inconsistent results regarding the association between vitamin D deficiency and mortality in patients with sepsis, and early-stage data regarding septic shock are limited. This study aimed to determine the relationship between vitamin D deficiency on admission to the emergency department (ED) and mortality in patients with septic shock.
We analyzed prospectively collected data on adult patients with septic shock who were treated with protocol-driven resuscitation bundle therapy in the ED between September 2019 and February 2021. Septic shock was defined by the sepsis-3 definition and vitamin D deficiency was defined as a 25-hydroxyvitamin D <20 ng/ml. The primary outcome was 30-day mortality.
A total of 302 patients were included, 236 (78.1%) patients had vitamin D deficiency; it was significantly higher in non-survivors than in survivors (89.3% vs. 73.9%, P = 0.004). Mortality was higher in vitamin D deficient patients than in non-deficient patients (31.8% vs. 13.6%, P = 0.004). In multivariate analysis, vitamin D deficiency (odds ratio [OR], 2.43; 95 % confidence interval [CI], 1.03–5.74), hyperlactatemia (OR, 3.65; 95 % CI, 1.95–6.83), Sequential Organ Failure Assessment scores (OR, 1.22; 95% CI, 1.09–1.36), and albumin levels (OR, 0.39; 95% CI, 0.21–0.73) were significantly associated with 30-day mortality.
Vitamin D deficiency was prevalent in patients with septic shock visiting the ED and was associated with mortality.
Sepsis is a life-threatening medical condition that results in significant morbidity and mortality. Each year, it affects over 750,000 patients in the United States and causes approximately 250,000 deaths.
Septic shock, occurring in approximately 15% of sepsis cases, is a medical emergency that accounts for 10% of intensive care unit (ICU) admissions and has a mortality rate of > 50%. The current guidelines for the management of sepsis and septic shock recommend urgent assessment and early application of protocol-driven resuscitation care bundle therapy. The management includes fluid resuscitation, performing blood cultures, and the administration of broad-spectrum antibiotics. Sepsis resuscitation generally focuses on macro-circulatory failures, such as decreased mean arterial pressure and cardiac output. However, a growing body of evidence suggests that the inability of the cell to consume oxygen may play a crucial role in the pathogenesis of sepsis. And that evidence entitled metabolic resuscitations for mitochondria such as the combination of vitamin C, thiamine, and corticosteroid. Vitamin D deficiency is prevalent in patients with critical illnesses and chronic diseases. In addition to its role in regulating calcium and phosphate metabolisms, vitamin D plays a key role in immunity, endothelial functioning, and the optimal functioning of antimicrobial activity. Previous studies have evaluated vitamin D deficiency as a diagnostic or predictive marker for infections. , Moreover, the association between vitamin D deficiency and the risk of infection has been reported in critically ill patients. A recent study has shown that vitamin D supplementation can reduce the risk of influenza and coronavirus disease (COVID-19). Although vitamin D deficiency is prevalent in patients with sepsis, evidence of the association between vitamin D deficiency and sepsis mortality is limited and inconsistent. Considering the role of vitamin D in maintaining the innate and adaptive immune systems
, we hypothesized that vitamin D deficiency is a surrogate marker of disease severity and may be a modifiable risk factor that could be rapidly treated via supplementation. We believe this investigation will result in high yields as, currently, no proven metabolic therapy is available for septic shock treatment. However, the prevalence of vitamin D deficiency and the association between vitamin D levels and mortality needs to be clarified.
Thus, this study aimed to determine the prevalence of vitamin D deficiency and investigate the relationship between vitamin D deficiency on admission to the emergency department (ED) and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy.