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Ann Med. 2016;48(1-2):67-75. doi: 10.3109/07853890.2015.1134807. Epub 2016 Jan 22.

Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study.

Author information

1
a Department of Anaesthesiology , University of Oulu , Oulu , Finland ;
2
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 ;
3
c Institute of Biomedicine and Biocenter of Oulu, University of Oulu , Oulu , Finland ;
4
d Medical Research Center Oulu, Oulu University Hospital , Oulu , Finland ;
5
e Division of Anaesthesia and Intensive Care Medicine, Department of Surgery , Intensive Care Units, Helsinki University Central Hospital , Helsinki , Finland ;
6
f Department of Anaesthesia and Intensive Care , Lapland Central Hospital , Rovaniemi , Finland.

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.

KEYWORDS:

Severe sepsis; critical illness; septic shock; vitamin D

PMID:
26800186
DOI:
10.3109/07853890.2015.1134807
[Indexed for MEDLINE]

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