title: Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study.
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 (<50 nmol/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 (<50 nmol/L: hazard ratio (HR) 0.99 (95% CI: 0.72-1.36), p > 0.9; and <25 nmol/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 messages In 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.
authors.affiliation: a Department of Anaesthesiology , University of Oulu , Oulu , Finland ;|b Division of Intensive Care Medicine, Medical Faculty , Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu , Oulu , Finland ;
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
authors.affiliation: c Institute of Biomedicine and Biocenter of Oulu, University of Oulu , Oulu , Finland ;|d Medical Research Center Oulu, Oulu University Hospital , Oulu , Finland ;
authors.forename: Shivaprakash J
authors.initials: SJ
authors.lastname: Mutt
authors.affiliation: e Division of Anaesthesia and Intensive Care Medicine, Department of Surgery , Intensive Care Units, Helsinki University Central Hospital , Helsinki , Finland ;
authors.forename: Sara
authors.initials: S
authors.lastname: Nisula
authors.affiliation: a Department of Anaesthesiology , University of Oulu , Oulu , Finland ;|b Division of Intensive Care Medicine, Medical Faculty , Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu , Oulu , Finland ;
authors.forename: Juha
authors.initials: J
authors.lastname: Koskenkari
authors.affiliation: a Department of Anaesthesiology , University of Oulu , Oulu , Finland ;|b Division of Intensive Care Medicine, Medical Faculty , Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu , Oulu , Finland ;
authors.forename: Janne
authors.initials: J
authors.lastname: Liisanantti
authors.affiliation: a Department of Anaesthesiology , University of Oulu , Oulu , Finland ;|b Division of Intensive Care Medicine, Medical Faculty , Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu , Oulu , Finland ;
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: f Department of Anaesthesia and Intensive Care , Lapland Central Hospital , Rovaniemi , Finland.
authors.forename: Meri
authors.initials: M
authors.lastname: Poukkanen
authors.affiliation: a Department of Anaesthesiology , University of Oulu , Oulu , Finland ;|b Division of Intensive Care Medicine, Medical Faculty , Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu , Oulu , Finland ;
authors.forename: Jouko J
authors.initials: JJ
authors.lastname: Laurila
authors.affiliation: e Division of Anaesthesia and Intensive Care Medicine, Department of Surgery , Intensive Care Units, Helsinki University Central Hospital , Helsinki , Finland ;
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.affiliation: c Institute of Biomedicine and Biocenter of Oulu, University of Oulu , Oulu , Finland ;|d Medical Research Center Oulu, Oulu University Hospital , Oulu , Finland ;
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herzig
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000097:blood / Q000401:mortality*; D012772:Shock, Septic / Q000097:blood / Q000401:mortality*; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000401:mortality*
chemical_list: D014807:Vitamin D
keywords: Severe sepsis; critical illness; septic shock; vitamin D