Serum vitamin D level variation in SIRS, sepsis and septic shock

Year 2019, , 102 - 106, 31.10.2019

Fethi Gul Mustafa K Arslantas Beliz Bılgılı Ahmet Besır Umut S Kasapoglu Sait Karakurt İsmail Cınel

https://doi.org/10.5472/marumj.637569

Cited By: 2

Abstract

Objectives: Vitamin D has potent immunomodulatory effects with the capability of acting as an autocrine and paracrine agent,

and inhibits inflammatory signaling. In this study, our aim was to evaluate the relationship between vitamin D levels in systemic

inflammatory response syndrome (SIRS), sepsis and, septic shock patients and outcomes.

Patients and Methods: A total of 45 patients whose vitamin D levels were measured within the first 48 hours of Intensive Care Unit

(ICU) admission and 20 healthy controls were studied prospectively. The patients were grouped as, SIRS (Group-I,n=10), sepsis

(Group-II,n=25), septic shock (Group-III,n=10) and healthy subjects (Group-IV,n=20). Serum vitamin D levels were categorized as

a deficiency (≤15ng/mL), insufficiency (16-29ng/mL) and sufficiency (≥30ng/mL). Demographic characteristics, Acute Physiology

and Chronic Health Assessment II (APACHE-II) scores, and biochemical parameters were noted.

Results: Vitamin D levels were significantly lower in all study groups compared to the control group (p<0.01), but were similar among

the study groups. The hospital and ICU length of stay (LOS), and biochemical parameters were similar among the study groups. The

mortality rates were 40% in Group I, 57 % in Group II, and 80 % in Group III.

Conclusion: In our study patients with SIRS, sepsis and septic shock had lower serum 25-OH vitamin D levels compared to the

control group. Our results are in line with the literature that supports a relationship between vitamin D deficiency and inflammation.

Keywords

Critically ill patients, Vitamin D, Sepsis, SIRS

References

• [1] Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.
• [2] Gul F, Arslantas MK, Cinel I, Kumar A. Changing definitions of sepsis. Turk J Anaesthesiol Reanim 2017;45:129-38. doi: 10.5152/TJAR.2017.93753.
• [3]. Atalan HK, Gucyetmez B. Serum vitamin D level at ICU admission and mortality. Turk J Anaesthesiol Reanim 2017;45:193-6. doi: 10.5152/TJAR.2017.60234.
• [4] Moraes RB, Friedman G, Wawrzeniak IC, et al. Vitamin D deficiency is independently associated with mortality among critically ill patients. Clinics 2015;70:326-32. doi: 10.6061/clinics/2015(05)04.
• [5] Kempker JA, Han JE, Tangpricha V, Ziegler TR, Martin GS. Vitamin D and sepsis: An emerging relationship. Dermatoendocrinol 2012;4:101-8. doi: 10.4161/derm.19859.
• [6] Parekh D, Patel JM, Scott A, et al. Vitamin D deficiency in human and murine sepsis. Crit Care Med 2017;45:282-9. doi: 10.1097/CCM.0000000000002095.
• [7] Rech MA, Hunsaker T, Rodriguez J. Deficiency in 25-hydroxyvitamin D and 30-day mortality in patients with severe sepsis and septic shock. Am J Crit Care 2014;23:e72-9. doi: 10.4037/ajcc2014723.
• [8] Amrein K, Christopher KB, McNally JD. Understanding vitamin D deficiency in intensive care patients. Intensive Care Med 2015;41:1961-4. doi: 10.1007/s00134-015-3937-4.
• [9] Moromizato T, Litonjua AA, Braun AB, Gibbons FK, Giovannucci E, Christopher KB. Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. Crit Care Med 2014;42:97-107. doi: 10.1097/CCM.0b013e31829eb7af.
• [10] Barnett N, Zhao Z, Koyama T, et al. Vitamin D deficiency and risk of acute lung injury in severe sepsis and severe trauma: a case-control study. Ann Intensive Care 2014;4:5. doi: 10.1186/2110-5820-4-5
• [11] Mirijello A, Tosoni A, Zaccone V, et al. MEDS score and vitamin D status are independent predictors of mortality in a cohort of Internal Medicine patients with microbiological identified sepsis. Eur Rev Med Pharmacol Sci 2019;23:4033-43. doi: 10.26355/eurrev_201905_17834.
• [12] Holick MF, Binkley NC, Bischoff-Ferrari HA, G, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30. doi: 10.1210/jc.2011-0385.
• [13] Gois PHF, Ferreira D, Olenski S, Seguro AC. Vitamin D and infectious diseases: Simple Bystander or Contributing Factor? Nutrients 2017;9. doi: 10.3390/nu9070651.
• [14] Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008;168:1629-37. doi: 10.1001/archinte.168.15.1629.
• [15] Pilz S, Iodice S, Zittermann A, Grant WB, Gandini S. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney Dis 2011;58:374-82. doi: 10.1053/j.ajkd.2011.03.020.
• [16] Teng M, Wolf M, Ofsthun MN, et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol 2005;16:1115-25. doi: 10.1681/ASN.2004070573
• [17] Azim A, Ahmed A, Yadav S, et al. Prevalence of vitamin D deficiency in critically ill patients and its influence on outcome: experience from a tertiary care centre in North India (an observational study). J Intensive Care 2013;1:14. doi: 10.1186/2052-0492-1-14.
• [18] Alves FS, Freitas FG, Bafi AT, Azevedo LC, Machado FR. Serum concentrations of vitamin D and organ dysfunction in patients with severe sepsis and septic shock. Rev Bras Ter Intensiva 2015;27:376-82. doi: 10.5935/0103-507X.20150063
• [19] de Haan K, Groeneveld AB, de Geus HR, Egal M, Struijs A. Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit Care 2014;18:660. doi: 10.1186/s13054-014-0660-4
• [20] Sanaie S, Mahmoodpoor A, Hamishehkar H, Fattahi S, Soleymani S, Faramarzi E. The relationship of serum vitamin D level with the outcome in surgical intensive care unit patients. Iran J Pharm Res 2019;18:1052-9. doi: 10.22037/ijpr.2019.1100658
• [21] McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN. Relationship between vitamin D status and ICU outcomes in veterans. J Am Med Dir Assoc 2011;12:208-11. doi: 10.1016/j.jamda.2010.04.004.
• [22] Zhou W, Mao S, Wu L, Yu J. Association Between Vitamin D Status and Sepsis. Clin Lab 2018;64:451-60. doi: 10.7754/Clin.Lab.2017.170919.
• [23] Upala S, Sanguankeo A, Permpalung N. Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis. BMC Anesthesiol 2015;15:84. doi: 10.1186/s12871-015-0063-3.
• [24] Shojaei M, Sabzeghabaei A, Valaei Barhagh H, Soltani S. The Correlation between serum level of Vitamin D and outcome of sepsis patients; a cross-sectional study. Arch Acad Emerg Med 2019;7:e1.
• [25] De Pascale G, Vallecoccia MS, Schiattarella A, et al. Clinical and microbiological outcome in septic patients with extremely low 25-hydroxyvitamin D levels at initiation of critical care. Clin Microbiol Infect 2016;22:456 e7- e13. doi: 10.1016/j.cmi.2015.12.015.
• [26] Amrein K, Zajic P, Schnedl C, et al. Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit Care 2014;18:R47. doi: 10.1186/cc13790.
• [27] Kempker JA, Tangpricha V, Ziegler TR, Martin GS. Vitamin D in sepsis: from basic science to clinical impact. Crit Care 2012;16:316. doi: 10.1186/cc11252.
• [28] Moller S, Laigaard F, Olgaard K, Hemmingsen C. Effect of 1,25-dihydroxy-vitamin D3 in experimental sepsis. Int J Med Sci 2007;4:190-5.
• [29] Ginde AA, Camargo CA, Jr., Shapiro NI. Vitamin D insufficiency and sepsis severity in emergency department patients with suspected infection. Acad Emerg Med 2011;18:551-4. doi: 10.1111/j.1553-2712.2011.01047.x.
• [30] Olejarova M, Dobisova A, Suchankova M, Tibenska E, Szaboova K, Koutun J, et al. Vitamin D deficiency - a potential risk factor for sepsis development, correlation with inflammatory markers, SOFA score and higher early mortality risk in sepsis. Bratisl Lek Listy 2019;120:284-90. doi: 10.4149/BLL_2019_040.
• [31] Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, et al. Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med 2009;7:28. doi: 10.1186/1479-5876-7-28.