A1 Refereed original research article in a scientific journal
Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study
Authors: Ala-Kokko TI, Mutt SJ, Nisula S, Koskenkari J, Liisanantti J, Ohtonen P, Poukkanen M, Laurila JJ, Pettila V, Herzig KH; FINNAKI Study Group
Publisher: TAYLOR & FRANCIS LTD
Publication year: 2016
Journal: Annals of Medicine
Journal name in source: ANNALS OF MEDICINE
Journal acronym: ANN MED
Volume: 48
Issue: 1-2
First page : 67
Last page: 75
Number of pages: 9
ISSN: 0785-3890
DOI: https://doi.org/10.3109/07853890.2015.1134807
Abstract
Introduction Low levels of vitamin D have been associated with increased mortality in patients that are critically ill. This study explored whether vitamin D levels were associated with 90-day mortality in severe sepsis or septic shock.Methods Plasma vitamin D levels were measured on admission to the intensive care unit (ICU) in a prospective multicentre observational study.Results 610 patients with severe sepsis were included; of these, 178 (29%) had septic shock. Vitamin D deficiency (<50nmol/L) was present in 333 (55%) patients. The 90-day mortality did not differ among patients with or without vitamin D deficiency (28.3% vs. 28.5%, p=0.789). Diabetes was more common among patients deficient compared to those not deficient in vitamin D (30% vs. 18%, p<0.001). Hospital-acquired infections at admission were more prevalent in patients with a vitamin D deficiency (31% vs. 16%, p<0.001). A multivariable adjusted Cox regression model showed that low vitamin D levels could not predict 90-day mortality (<50nmol/L: hazard ratio (HR) 0.99 (95% CI: 0.72-1.36), p>0.9; and <25nmol/L: HR 0.44 (95% CI: 0.22-0.87), p=0.018).Conclusions Vitamin D deficiency detected upon ICU admission was not associated with 90-day mortality in patients with severe sepsis or septic shock.Key messagesIn severe sepsis and septic shock, a vitamin D deficiency upon ICU admission was not associated with increased mortality.Compared to patients with sufficient vitamin D, patients with deficient vitamin D more frequently exhibited diabetes, elevated C-reactive protein levels, and hospital-acquired infections upon ICU admission, and they more frequently developed acute kidney injury.
Introduction Low levels of vitamin D have been associated with increased mortality in patients that are critically ill. This study explored whether vitamin D levels were associated with 90-day mortality in severe sepsis or septic shock.Methods Plasma vitamin D levels were measured on admission to the intensive care unit (ICU) in a prospective multicentre observational study.Results 610 patients with severe sepsis were included; of these, 178 (29%) had septic shock. Vitamin D deficiency (<50nmol/L) was present in 333 (55%) patients. The 90-day mortality did not differ among patients with or without vitamin D deficiency (28.3% vs. 28.5%, p=0.789). Diabetes was more common among patients deficient compared to those not deficient in vitamin D (30% vs. 18%, p<0.001). Hospital-acquired infections at admission were more prevalent in patients with a vitamin D deficiency (31% vs. 16%, p<0.001). A multivariable adjusted Cox regression model showed that low vitamin D levels could not predict 90-day mortality (<50nmol/L: hazard ratio (HR) 0.99 (95% CI: 0.72-1.36), p>0.9; and <25nmol/L: HR 0.44 (95% CI: 0.22-0.87), p=0.018).Conclusions Vitamin D deficiency detected upon ICU admission was not associated with 90-day mortality in patients with severe sepsis or septic shock.Key messagesIn severe sepsis and septic shock, a vitamin D deficiency upon ICU admission was not associated with increased mortality.Compared to patients with sufficient vitamin D, patients with deficient vitamin D more frequently exhibited diabetes, elevated C-reactive protein levels, and hospital-acquired infections upon ICU admission, and they more frequently developed acute kidney injury.
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