Volume 3 Supplement 1

ESICM LIVES 2015

Open Access

Clinical outcome of septic patients with undetectable vitamin D levels at ICU admission

  • G De Pascale1,
  • MS Vallecoccia1,
  • E Gasperin1,
  • D Giacobelli1,
  • A Schiattarella2,
  • A Autunno1,
  • V Di Gravio1,
  • S Marsili1,
  • SL Cutuli1,
  • MA Pennisi1,
  • C Zuppi2,
  • SA Quraishi3 and
  • M Antonelli1
Intensive Care Medicine Experimental20153(Suppl 1):A80

https://doi.org/10.1186/2197-425X-3-S1-A80

Published: 1 October 2015

Introduction

Septic patients with very low vitamin D (VD) levels are expected to most benefit from supplementation strategies but few data are available in this specific population.[1]

Objectives

Our purpose is to investigate the clinical/epidemiological profile and sepsis-related outcome of critically ill septic patients with undetectable VD levels at ICU admission.

Methods

We conducted an observational study enrolling, during a 12 months period, consecutive patients admitted to our ICU with severe sepsis/septic shock.

Results

170 blood samples were obtained from 107 patients (septic shock / severe sepsis: 62% / 38%). ICU admission VD deficiency (≤ 20ng/mL) was observed in 93.5% of the patients: 57 (53.3%) showed undetectable levels ( < 7ng/mL). In patients (n = 33) who received, during the ICU stay, more than one VD blood sampling, hypovitaminosis D category did not change over time (p=ns). The principal infection site was the lung (48.6%): 50 (46.7%) patients were bacteraemic. Comparing patients with undetectable VD levels with those ones with values ≥ 7ng/mL, there were not significant differences regarding main comorbidities, presenting features and disease severity (p=ns). The former group showed a higher rate of microbiologically confirmed infections but a lower percentage of microbiological eradication (80.7% vs. 58%, p = 0.02; 35.3% vs 68%; p = 0.03, respectively). Furthermore they experienced longer duration of mechanical ventilation and vasopressor support: 9 ds [3.75-12.5] vs. 4 ds [2-0], p = 0.04; 7 ds [4-10] vs. 4 ds [2-7.25], p= 0.02. Sepsis-related mortality rate was higher in patients with VD levels < 7ng/mL (50.9% vs 26%). Multivariable regression analysis confirmed ICU admission undetectable VD concentration (p = 0.01) as independent predictor of sepsis-related mortality.

Conclusions

Our results suggest that in critically ill septic patients undetectable VD levels at ICU admission may be a major determinant of clinical outcome. Further studies should assess the impact of replacement strategies in this subgroup of patients.

Authors’ Affiliations

(1)
Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, A. Gemelli Hospital
(2)
Institute of Biochemestry and Clinical Biochemestry, Sacro Cuore Catholic University, A. Gemelli Hospital
(3)
Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital

References

  1. Amrein K, et al: Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. Jama. 2014, 312 (15): 1520-30. 10.1001/jama.2014.13204.PubMedView ArticleGoogle Scholar

Copyright

© De Pascale et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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