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  • Severe vitamin D deficiency in patients admitted to the emergency department with severe sepsis is associated with an increased 90-day mortality

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Original research
Severe vitamin D deficiency in patients admitted to the emergency department with severe sepsis is associated with an increased 90-day mortality
  1. Stefano Malinverni1,
  2. Queitan Ochogavia1,
  3. Sarah Lecrenier1,
  4. Margherita Scorpinniti2,
  5. Jean-Charles Preiser3,
  6. Frederic Cotton4,
  7. Pierre Mols1,
  8. Magali Bartiaux1
  1. 1 Emergency Department, CHU Saint-Pierre, Bruxelles, Belgium
  2. 2 Emergency Department, San Donato Hospital, Arezzo, Italy
  3. 3 Intensive Care, Erasmus Hospital, Bruxelles, Belgium
  4. 4 LHUB-ULB, Clinical Chemestry, ULB, Bruxelles, Belgium
  1. Correspondence to Dr Stefano Malinverni, Emergency Medicine, CHU Saint-Pierre, Bruxelles 1000, Belgium; stefano_malinverni{at}stpierre-bru.be

Abstract

Background The role of vitamin D in the response to infection has been increasingly acknowledged. However, the influence of severe vitamin D deficiency on the outcome of patients admitted for severe sepsis is unknown. Hence, this study aimed to investigate the association between severe vitamin D deficiency and sepsis-related outcomes in patients presenting to the ED.

Methods This single centre prospective study included patients presenting to the ED with severe sepsis from April 2014 until December 2017. 25-Hydroxy vitamin D (25(OH)D) was measured in a blood sample drawn within 24 hours of admission to the ED, and severe vitamin D deficiency was defined as 25(OH)D <12 ng/mL. 90-day mortality was compared between patients with and without severe vitamin D deficiency by a multivariable analysis adjusting for confounders and according to a Kaplan-Meier survival analysis.

Results 263 patients were initially screened and 164 patients with severe sepsis were included in this study, 18% of whom had septic shock. Severe vitamin D deficiency was present in 46% of patients. The overall 90-day mortality rate was 26.2% and the median length of stay was 14 days. In a logistic regression accounting for sepsis severity and age-adjusted comorbidities, severe vitamin D deficiency was associated with increased mortality (OR=2.69 (95% CI 1.03 to 7.00), p=0.043), and lower chances of hospital discharge (sub-HR=0.66 (95% CI 0.44 to 0.98)). In the subgroup of patients admitted to the intensive care unit, severe vitamin D deficiency was associated with an increased 28-day adjusted mortality (HR=3.06 (95% CI 1.05 to 8.94), p=0.04) and lower chances of discharge (sub-HR=0.51 (95% CI 0.32 to 0.81)).

Conclusions Severe vitamin D deficiency at ED admission is associated with higher mortality and longer hospital stay in patients with severe sepsis.

  • resuscitation
  • metabolic
  • pneumonia
  • urgent care
  • infections

Data availability statement

Data are available in a public, open access repository. Data are available at the following DOI: 10.6084/m9.figshare.13573502.

https://doi.org/10.1136/emermed-2021-211973

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    Data availability statement

    Data are available in a public, open access repository. Data are available at the following DOI: 10.6084/m9.figshare.13573502.

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    Footnotes

    • Handling editor Ellen J Weber

    • Contributors SM substantially contributed to the conception and design of the study, the acquisition and both the analysis and interpretation of the data. SM drafted the article and provided final approval of the version submitted for publication. SM acts as the guarantor of the study. QO substantially contributed to the conception and design of the study as well as the acquisition of the data. QO provided critical revision to the article and approved the final version of the manuscript submitted for publication. SL substantially contributed to the analysis and interpretation of the data. SL provided critical revision to the article and approved the final version of the manuscript submitted for publication. MS substantially contributed to the acquisition of the data. MS provided critical revision to the article and approved the final version of the manuscript submitted for publication. FC substantially contributed to the acquisition and interpretation of the data. FC provided critical revision to the article and approved the final version of the manuscript submitted for publication. J-CP substantially contributed to the analysis and interpretation of the data. J-CP provided critical revision to the article and approved the final version of the manuscript submitted for publication. PM substantially contributed to the interpretation of the data. PM provided critical revision to the article and approved the final version of the manuscript submitted for publication. MB substantially contributed to the interpretation of the data. MB provided critical revision to the article and approved the final version of the manuscript submitted for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests J-CP is the national coordinator of the VITDALIZE study.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.