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Vitamin D Insufficiency and Sepsis Severity in Emergency Department Patients With Suspected Infection.
MedLine Citation:
PMID:  21518095     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ACADEMIC EMERGENCY MEDICINE 2011; 18:1-4 © 2011 by the Society for Academic Emergency Medicine ABSTRACT: Objectives:  Vitamin D is increasingly recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of sepsis. We sought to evaluate the association between vitamin D status and sepsis severity and hypothesized that vitamin D insufficiency would be associated with increased sepsis severity. Methods:  This was a pilot study of emergency department (ED) patients age ≥18 years evaluated for suspected infection at an urban, teaching hospital. The authors measured illness severity using the following assessments at baseline and 24 hours: 1) severe sepsis, defined as suspected infection plus two or more elements of systemic inflammatory response syndrome criteria and acute dysfunction of one or more organ systems; 2) Acute Physiology Age Chronic Health Evaluation (APACHE) II scores; and 3) Sepsis-related Organ Failure Assessment (SOFA) scores. Vitamin D insufficiency was defined as baseline serum 25-hydroxyvitamin D (25OHD) levels <75 nmol/L. Results:  Eighty-one patients were enrolled, with a median age of 62 years (interquartile range [IQR] = 48-76 years), 47% were female, and 77% were white. At baseline, 64 (79%) had 25OHD levels of <75 nmol/L, and 43 (53%) had severe sepsis. At 24 hours, 48 (59%) had severe sepsis. Patients with baseline 25OHD levels of <75 nmol/L, compared to patients with 25OHD levels of ≥75 nmol/L, were more likely to have severe sepsis (61% vs. 24%; p = 0.006) and SOFA scores ≥2 (44% vs. 18%; p = 0.049). Additionally, at 24 hours, those with 25OHD levels of <75 nmol/L were more likely to have severe sepsis (67% vs. 29%; p = 0.005), dysfunction of two or more organ systems (50% vs. 18%; p = 0.02), APACHE II score of ≥25 (19% vs. 0%; p = 0.06), and SOFA scores of ≥2 (63% vs. 29%; p = 0.02). Additionally, all four patients who died during the index hospitalization had 25OHD levels of <75 nmol/L. Conclusions:  Vitamin D insufficiency was associated with higher sepsis severity in ED patients hospitalized for suspected infection. Larger observational studies, mechanistic studies, and ultimately randomized controlled trials are needed to determine causation and to evaluate if vitamin D supplementation can reduce the risk of sepsis as a preventive or therapeutic strategy.
Authors:
Adit A Ginde; Carlos A Camargo; Nathan I Shapiro
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-22
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  -     ISSN:  1553-2712     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 by the Society for Academic Emergency Medicine.
Affiliation:
From the Department of Emergency Medicine, University of Colorado School of Medicine (AAG), Aurora, CO; the Department of Emergency Medicine, Massachusetts General Hospital (CAC), and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (NIS), Harvard Medical School, Boston, MA.
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