title: Clinical and microbiological outcome in septic patients with extremely low 25-hydroxyvitamin D levels at initiation of critical care.
abstract: A relationship between vitamin D status and mortality in patients in intensive care units (ICU) has been documented. The present study aims to describe the clinical profile and sepsis-related outcome of critically ill septic patients with extremely low (<7 ng/mL) vitamin D 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 vitamin D deficiency (≤20 ng/mL) was observed in 93.5% of the patients: 57 (53.3%) showed levels <7 ng/mL. As primary outcome, sepsis-related mortality rate was higher in patients with vitamin D levels <7 ng/mL (50.9% versus 26%). Multivariate regression analysis showed that vitamin D 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 vitamin D levels suffered higher rate of microbiologically confirmed infections but a lower percentage of microbiological eradication with respect to patients whose values were >7 ng/mL (80.7% versus 58%, p 0.02; 35.3% versus 68%; p 0.03, respectively). Post hoc analysis showed that, in the extremely low vitamin D group, the 52 patients with pneumonia showed a longer duration of mechanical ventilation (9 days (3.75-12.5 days) versus 4 days (2-9 days), p 0.04) and the 66 with septic shock needed vasopressor support for a longer period of time (7 days (4-10 days) versus 4 days (2-7.25 days), p 0.02). Our results suggest that in critical septic patients extremely low vitamin D levels on admission may be a major determinant of clinical outcome. Benefits of vitamin D replacement therapy in this population should be elucidated.
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy. Electronic address: gennaro.depascale@email.it.
authors.forename: G
authors.initials: G
authors.lastname: De Pascale
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: M S
authors.initials: MS
authors.lastname: Vallecoccia
authors.affiliation: Institute of Biochemistry and Clinical Biochemistry, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Schiattarella
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Gravio
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: S L
authors.initials: SL
authors.lastname: Cutuli
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bello
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Montini
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Pennisi
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Spanu
authors.affiliation: Institute of Biochemistry and Clinical Biochemistry, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Zuppi
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Anesthesia, Harvard Medical School, Boston, MA, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Quraishi
authors.affiliation: Department of Intensive Care and Anaesthesiology, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Critical care medicine; intensive care unit admission; nutrition; outcome; sepsis; vitamin D