Is There a Link Between Vitamin D Deficiency and Septic Shock Mortality?
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Is There a Link Between Vitamin D Deficiency and Septic Shock Mortality?
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Is There a Link Between Vitamin D Deficiency and Septic Shock Mortality?
In a recent study published in the journal “Nutrients,” researchers examined the impact of low serum vitamin D levels on the prognosis of septic shock.
Background:
Sepsis is a potentially life-threatening condition and a significant global health concern. Research suggests that vitamin D deficiency is associated with an increased mortality rate in older individuals.
While vitamin D is crucial for mineral and bone metabolism, recent studies have linked it to conditions like cancer, viral diseases, autoimmune disorders, cardiovascular diseases, and diabetes.
Prior research has connected vitamin D deficiency to higher mortality rates among septic shock patients, but other randomized control trials have not revealed significant correlations, and there is no evidence that supplementing vitamin D improves septic shock mortality.
About the Study:
This study investigated whether vitamin D intake affects sepsis-related mortality. The study included 129 individuals with septic shock (as assessed by Sequential Organ Failure Assessment – SOFA – score of 2.0 or higher) who were admitted to the emergency department at Korea University Ansan Hospital between January 2019 and January the following year.
Patients with septic shock required vasopressors to maintain their mean arterial pressure (MAP) at 65 mm Hg or higher and had serum lactate levels of ≥2.0 mmol/L.
Data on study subjects included age, gender, Charlson Comorbidity Index (CCI) levels, and underlying diseases. SOFA scores were determined during the initial septic shock diagnosis, and blood samples were collected for serum lactate, C-reactive protein (CRP), and procalcitonin measurements.
The time to administer antibiotics after diagnosing septic shock and the appropriateness of empiric antibiotic therapy were assessed. Study outcomes included length of hospital stay and in-hospital mortality rates at one, two, four, and weeks.
Serum vitamin D levels (25-hydroxyvitamin D) were measured in blood using chemiluminescent microparticle immunoassays. Vitamin D levels below 20 ng/mL indicated deficiency, while levels below 12.0 ng/mL indicated severe deficiency.
Vitamin D levels between 20 and 30 ng/mL suggested insufficiency. Adjusted hazard ratios (aHRs) were calculated after controlling for factors like age, gender, CCI, CRP levels, lactate levels, procalcitonin levels, SOFA scores, and the appropriateness and timing of antibiotic treatment.
Results:
The median age, SOFA score, and vitamin D level of the subjects were 74 years, 7.0, and 13.0 ng/mL, respectively. Sixty individuals experienced septic shock.
Among the participants, 96 (74%) had vitamin D deficiency, 62 (48%) had severe vitamin D deficiency, and 19 (92%) had vitamin D insufficiency.
In the vitamin D-deficient group, 42 (44%) were male, while in the severe vitamin D deficiency group, 27 (44%) were male.
Reportedly, 60 (63%) of vitamin D-deficient individuals and 36 (38%) of individuals with severe vitamin D deficiency developed infections. Bacteremia was observed in 36 (38%) and 21 (34%) individuals with vitamin D deficiency and severe vitamin D deficiency, respectively.
Individuals with severe vitamin D deficiency had significantly higher two-week and four-week mortality rates compared to those without vitamin D deficiency.
Notably, severe vitamin D deficiency significantly increased two-week, four-week, and in-hospital mortality rates, with aHR values of 2.6, 2.3, and 2.1, respectively.
Sixty-three (66%) individuals with serum vitamin D deficiency and 39 (63%) with severe vitamin D deficiency were admitted to the intensive care unit (ICU). Median CRP levels for vitamin D-deficient and severely deficient individuals were 10 and 11 mg/L, respectively.
Respective median procalcitonin levels were 1.1 and 0.9 ng/mL, and lactate median levels were 2.7 and 2.30 mmol/L.
The median time to initiate antibiotics for vitamin D-deficient individuals was 115 minutes, while it was 130 minutes for those with severe vitamin D deficiency; antibiotic treatment was appropriate for 75% and 81% of the respective groups.
The all-cause one-week mortality rate for the sample population was 10%, 12% for those with vitamin D deficiency, 15% for those with severe vitamin D deficiency, and 11% for those with vitamin D insufficiency.
The respective all-cause two-week mortality rates were 17%, 21%, 25%, and 19%. Four-week mortality rates were 30%, 32%, 39%, and 30%.
In the sample population, the in-hospital mortality rates for the overall sample, vitamin D-deficient individuals, individuals with severe vitamin D deficiency, and those with vitamin D insufficiency were 28%, 31%, 36%, and 29%.
The biological basis of vitamin D deficiency’s impact on septic shock mortality is still unclear. The study report suggests that vitamin D deficiency reduces the number of vitamin D receptors (VDR) and anti-inflammatory immune responses.
Vitamin D enhances the expression of nucleotide-binding oligomerization domain 2 (NOD2) and toll-like receptor 2 (TLR2) in animal models and triggers antimicrobial human neutrophil peptides vital for adaptive immunity.
Conclusion:
Overall, the study results indicate that severe vitamin D deficiency increases the two-week, four-week, and in-hospital mortality rates of septic shock patients, as shown by aHR values higher than CCI and SOFA values.
Evaluating vitamin D levels in septic shock patients may be crucial for older individuals. Severe vitamin D deficiency levels may independently impair septic shock-related outcomes.
Further research is needed to determine whether supplementing vitamin D in individuals diagnosed with septic shock improves bone metabolism and septic shock prognosis.
Is There a Link Between Vitamin D Deficiency and Septic Shock Mortality?
Reference:
Seok, H.; Kim, J.; Choi, W.S.; Park, D.W. (2023) Effects of Vitamin D Deficiency on Sepsis, Nutrients, doi: https://doi.org/10.3390/nu15204309. https://www.mdpi.com/2072-6643/15/20/4309
(source:internet, reference only)
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