PMID- 21518095
OWN - NLM
STAT- MEDLINE
DCOM- 20110907
LR  - 20110516
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 18
IP  - 5
DP  - 2011 May
TI  - Vitamin D insufficiency and sepsis severity in emergency department patients with 
      suspected infection.
PG  - 551-4
LID - 10.1111/j.1553-2712.2011.01047.x [doi]
AB  - 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.
CI  - (c) 2011 by the Society for Academic Emergency Medicine.
FAU - Ginde, Adit A
AU  - Ginde AA
AD  - Department of Emergency Medicine, University of Colorado School of Medicine 
      (AAG), Aurora, CO, USA. adit.ginde@ucdenver.edu
FAU - Camargo, Carlos A Jr
AU  - Camargo CA Jr
FAU - Shapiro, Nathan I
AU  - Shapiro NI
LA  - eng
PT  - Journal Article
DEP - 20110422
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Emergency Service, Hospital
MH  - Female
MH  - Hospitals, Teaching
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Sepsis/*complications/*epidemiology
MH  - Severity of Illness Index
MH  - Vitamin D Deficiency/blood/*complications
EDAT- 2011/04/27 06:00
MHDA- 2011/09/08 06:00
CRDT- 2011/04/27 06:00
PHST- 2011/04/27 06:00 [entrez]
PHST- 2011/04/27 06:00 [pubmed]
PHST- 2011/09/08 06:00 [medline]
AID - 10.1111/j.1553-2712.2011.01047.x [doi]
PST - ppublish
SO  - Acad Emerg Med. 2011 May;18(5):551-4. doi: 10.1111/j.1553-2712.2011.01047.x. Epub 
      2011 Apr 22.