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Thampi SJ, Basheer A, Thomas K. Calcitriol in Sepsis-A Single-Centre Randomised Control Trial. J Clin Med 2024; 13:3823. [PMID: 38999389 PMCID: PMC11242284 DOI: 10.3390/jcm13133823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis is a significant cause of hospital admission and the leading reason for admission to the ICU and is associated with high mortality. Vitamin D has shown promising immunomodulatory effects by upregulating the antimicrobial peptide, cathelicidin. However, previous studies analysing the use of calcitriol in sepsis have shown variable results and did not utilise APACHE II (Acute Physiology and Chronic Health Evaluation II) scores as endpoints. This study evaluates the efficacy of intramuscular calcitriol in patients admitted to the ICU with sepsis, focusing on its impact on APACHE II scores. The primary aim was to determine if intramuscular calcitriol improved APACHE II scores from day 1 to day 7 or discharge from the ICU, whichever was earlier. Secondary outcomes included 28-day mortality, ventilator days, vasopressor days, ICU stay length, adverse events, and hospital-acquired infections in ICU patients. Methods: This was a triple-blinded phase III randomised control trial. A total of 152 patients with suspected sepsis were block-randomised to receive either intramuscular calcitriol (300,000 IU) (n = 76) or a placebo (n = 76). The trial was registered with the Clinical Trials Registry-India (CTRI No: CTRI 2019/01/17066) following ethics committee approval and was not funded. Results: There was no significant difference in APACHE II scores between the calcitriol and placebo groups from day 1 to day 7 (p = 0.382). There were no significant changes in 28-day mortality (14.4% vs. 17%, p = 0.65), number of days on a ventilator (5 vs. 5, p = 0.84), number of days on vasopressors (3 vs. 3, p = 0.98), length of ICU stay (10 days vs. 11 days, p = 0.78), adverse events (27.6% vs. 19.7%, p = 0.25), and hospital-acquired infections (17.1% vs. 15.8%, p = 0.82). Conclusions: There was no effect of intramuscular calcitriol in patients admitted to the ICU with sepsis.
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Affiliation(s)
- Siddhant Jeevan Thampi
- Department of Acute Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Aneesh Basheer
- Department of Internal Medicine, Dr. Moopen’s Medical College, Wayanad 673577, India;
| | - Kurien Thomas
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Puducherry 605014, India;
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Haghighi Bardineh SA, Balou HA, Sedigh Ebrahim‐Saraie H, Mobayen M, Esmailzadeh M, Haghighi S, Haghighi A, Sadeghi M. Predictive value of serum albumin and calcium levels in burn patients with Pseudomonas aeruginosa infection: A comprehensive analysis of clinical outcomes. Int Wound J 2024; 21:e14786. [PMID: 38385765 PMCID: PMC10883257 DOI: 10.1111/iwj.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
In the ongoing challenge to reduce burn-associated mortality rates, this study explores the predictive capacity of clinical factors in burn patients, focusing on vitamin D, calcium, and serum albumin levels during hospitalisation in cases with Pseudomonas aeruginosa infection. Our research involves a comprehensive analysis of 100 burn patients, encompassing crucial clinical parameters such as the burn severity index, serum albumin, vitamin D, and calcium levels at admission. Data were meticulously entered into IBM Statistics SPSS software version 28 and subjected to statistical analysis. The study reveals an average patient age of 39.75 years and a notable 34% mortality rate. Additionally, the average lengths of hospital and intensive care unit (ICU) stays are determined to be 11.33 and 7.79 days, respectively. Significantly, a correlation between calcium and albumin variables and treatment outcomes is established, showcasing their potential to predict variable changes in patient mortality rates. Furthermore, a noteworthy association is observed between serum calcium levels and the duration of ICU hospitalisation. In conclusion, albumin and calcium variables emerge as sensitive and specific indicators for predicting outcomes in burn patients. Importantly, the independence of these factors from the physician's experience and diagnosis reduces human error and thus increases the accuracy of mortality prediction in this patient population.
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Affiliation(s)
| | - Heydar Ali Balou
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Hadi Sedigh Ebrahim‐Saraie
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
- Department of Microbiology, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mojdeh Esmailzadeh
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Samane Haghighi
- Institute of Theoretical and Translational MedicineSemmelweis UniversityBudapestHungary
| | - Arezoo Haghighi
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical SciencesSemmelweis UniversityBudapestHungary
| | - Mahsa Sadeghi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Microbiology, School of MedicineGuilan University of Medical SciencesRashtIran
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Wei Z, Liu Y, Mei X, Zhong J, Huang F. Circulating micronutrient levels and their association with sepsis susceptibility and severity: a Mendelian randomization study. Front Genet 2024; 15:1353118. [PMID: 38435062 PMCID: PMC10904592 DOI: 10.3389/fgene.2024.1353118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Background: Sepsis, a global health challenge, necessitates a nuanced understanding of modifiable factors for effective prevention and intervention. The role of trace micronutrients in sepsis pathogenesis remains unclear, and their potential connection, especially with genetic influences, warrants exploration. Methods: We employed Mendelian randomization (MR) analyses to assess the causal relationship between genetically predicted blood levels of nine micronutrients (calcium, β-carotene, iron, magnesium, phosphorus, vitamin C, vitamin B6, vitamin D, and zinc) and sepsis susceptibility, severity, and subtypes. The instrumental variables for circulating micronutrients were derived from nine published genome-wide association studies (GWAS). In the primary MR analysis, we utilized summary statistics for sepsis from two independent databases (UK Biobank and FinnGen consortium), for initial and replication analyses. Subsequently, a meta-analysis was conducted to merge the results. In secondary MR analyses, we assessed the causal effects of micronutrients on five sepsis-related outcomes (severe sepsis, sepsis-related death within 28 days, severe sepsis-related death within 28 days, streptococcal septicaemia, and puerperal sepsis), incorporating multiple sensitivity analyses and multivariable MR to address potential heterogeneity and pleiotropy. Results: The study revealed a significant causal link between genetically forecasted zinc levels and reduced risk of severe sepsis-related death within 28 days (odds ratio [OR] = 0.450; 95% confidence interval [CI]: 0.263, 0.770; p = 3.58 × 10-3). Additionally, suggestive associations were found for iron (increased risk of sepsis), β-carotene (reduced risk of sepsis death) and vitamin C (decreased risk of puerperal sepsis). No significant connections were observed for other micronutrients. Conclusion: Our study highlighted that zinc may emerges as a potential protective factor against severe sepsis-related death within 28 days, providing theoretical support for supplementing zinc in high-risk critically ill sepsis patients. In the future, larger-scale data are needed to validate our findings.
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Affiliation(s)
- Zhengxiao Wei
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Yingfen Liu
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Xue Mei
- Department of Infectious Diseases, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Jing Zhong
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Fuhong Huang
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Pirdastan S, Mahdavi Roshan M, Mobayen M, Asadzadegan R, Ebrahim Ghafari M, Mazhari SA, Sadeghi M, Bagheri Toolaroud P, Alizadeh Otaghvar H. Effect of vitamin D on clinical outcomes in patients with thermal injury. Int Wound J 2024; 21:e14641. [PMID: 38379253 PMCID: PMC10828730 DOI: 10.1111/iwj.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 02/22/2024] Open
Abstract
Evaluating complications and mortality risks in burn patients is crucial for effective treatment planning and improving survival rates. This study investigated the relationship between the serum vitamin D level and the clinical outcomes of adult burns patients. This was a prospective cohort of adult patients hospitalized due to thermal burns at a burn centre in the north of Iran. Based on the level of 25 hydroxyvitamin D measured upon admission, patients were divided into two groups of patients with sufficient 25 hydroxyvitamin D level and insufficient 25 hydroxyvitamin D level. Descriptive statistics were used for baseline demographics. Univariate analysis was conducted using Mann-Whitney U, Chi-square, independent samples, and Fisher's exact tests. A multivariate logistic regression was performed to adjust for the effects of confounding variables. Statistical analyses were conducted using SPSS 28.0 software. A total of 220 patients were included in the study. The average total body surface area burned was 30.52 ± 9.34. Patients with insufficient vitamin D levels had longer hospital stays (12.53 vs. 11.45) and longer stays in the intensive care unit (ICU) (3.32 vs. 2.40) than those with appropriate vitamin D levels. Participants with insufficient vitamin D levels exhibited a numerically higher incidence of infections than those with adequate levels (p < 0.05). The multivariate regression found that vitamin D deficiency levels were associated with increased infection rates and prolonged hospital stay. This study suggests that vitamin D deficiency is a significant risk factor for adverse clinical outcomes in burn patients. Further research is needed to confirm these associations and to explore potential interventions to optimize vitamin D status in this patient population.
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Affiliation(s)
- Sepide Pirdastan
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Marjan Mahdavi Roshan
- Cardiovascular Disease Research Center, Department of Cardiology, Heshmat Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Reza Asadzadegan
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mohammad Ebrahim Ghafari
- Department of Biostatistics and Epidemiology, Faculty of HealthQom University of Medical SciencesQomIran
| | | | - Mahsa Sadeghi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Parissa Bagheri Toolaroud
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Health Information Management Research CenterKashan University of Medical SciencesKashanIran
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Ananta Kahar L, Yusrawati Y, Jamsari J, Maskoen T, Aribowo K, Monika Sari W. The Role of Vitamin D Binding Protein and Vitamin D Level in Mortality of Sepsis Patients. Rep Biochem Mol Biol 2023; 12:366-373. [PMID: 38618268 PMCID: PMC11015934 DOI: 10.61186/rbmb.12.3.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/15/2023] [Indexed: 04/16/2024]
Abstract
Background Vitamin D plays crucial roles in immune cell function, including macrophage activation, immune response modulation, and antimicrobial peptide production. Low vitamin D levels can result in reduced immune response, heightened inflammation, and impaired organ function, thereby exacerbating sepsis severity and impacting patient prognosis. This study investigates the influence of vitamin D binding protein expression and vitamin D levels on the mortality of septic patients. Methods This analytical observational study employs a case-control approach and involves patients at the Critical Care Unit of Dr. M. Djamil General Hospital in Padang, Indonesia. The study comprises 40 patients in the case group and 40 patients in the control group. Vitamin D and vitamin D binding protein levels are assessed using the enzyme-linked immunosorbent assay method. Results Vitamin D and vitamin D binding protein levels were observed to be lower in the case group compared to the control group. In the case group, the majority of patients had vitamin D binding protein levels below 200 µg/mL. A significant association was found between vitamin D levels and mortality in sepsis patients (P< 0.05). Patients with vitamin D levels below 20 µg/mL faced a 2.54 times higher risk of mortality than those with levels exceeding 20 µg/mL. Conclusions Diminished levels of vitamin D binding protein and vitamin D contribute to an increased risk of mortality in septic patients.
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Affiliation(s)
- Liliriawati Ananta Kahar
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Andalas University, Dr. M. Djamil General Hospital, Padang, 25171, Indonesia.
| | - Yusrawati Yusrawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Andalas University, Padang, 25171, Indonesia.
| | - Jamsari Jamsari
- Department of Biotechnology, Postgraduate Program, Andalas University, Padang, 25163, Indonesia.
| | - Tinni Maskoen
- Faculty of Medicine, Padjadjaran University, Bandung, 45363, Indonesia.
| | - Kornelis Aribowo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Andalas University, Padang, 25171, Indonesia.
| | - Wiwi Monika Sari
- Intensive Care Unit, Dr. M. Djamil General Hospital, Padang, 25171, Indonesia.
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Chae B, Kim YJ, Kim SM, Hong SI, Shin YS, Kim JS, Ryoo SM, Kim WY. Vitamin D deficiency on admission to the emergency department is a mortality predictor for patients with septic shock treated with early protocol-driven resuscitation bundle therapy. Am J Med Sci 2023; 365:361-367. [PMID: 36265656 DOI: 10.1016/j.amjms.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/16/2022] [Accepted: 10/13/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Vitamin D is an important immune modulator and is associated with susceptibility to infection. However, past studies have reported inconsistent results regarding the association between vitamin D deficiency and mortality in patients with sepsis, and early-stage data regarding septic shock are limited. This study aimed to determine the relationship between vitamin D deficiency on admission to the emergency department (ED) and mortality in patients with septic shock. METHODS We analyzed prospectively collected data on adult patients with septic shock who were treated with protocol-driven resuscitation bundle therapy in the ED between September 2019 and February 2021. Septic shock was defined by the sepsis-3 definition and vitamin D deficiency was defined as a 25-hydroxyvitamin D <20 ng/ml. The primary outcome was 30-day mortality. RESULTS A total of 302 patients were included, 236 (78.1%) patients had vitamin D deficiency; it was significantly higher in non-survivors than in survivors (89.3% vs. 73.9%, P = 0.004). Mortality was higher in vitamin D deficient patients than in non-deficient patients (31.8% vs. 13.6%, P = 0.004). In multivariate analysis, vitamin D deficiency (odds ratio [OR], 2.43; 95 % confidence interval [CI], 1.03-5.74), hyperlactatemia (OR, 3.65; 95 % CI, 1.95-6.83), Sequential Organ Failure Assessment scores (OR, 1.22; 95% CI, 1.09-1.36), and albumin levels (OR, 0.39; 95% CI, 0.21-0.73) were significantly associated with 30-day mortality. CONCLUSIONS Vitamin D deficiency was prevalent in patients with septic shock visiting the ED and was associated with mortality.
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Affiliation(s)
- Bora Chae
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Min Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seok-In Hong
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yo Sep Shin
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - June-Sung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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YAKIŞIK ÇAKIR E, YÜCEL Ç, KIZILGÜN M, ÖZKOÇAK TURAN I. Kalsiyum, D vitamini ve paratiroid hormon düzeylerinin kritik hastaların prognozuna etkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1124112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Sepsisli hastalarda elektrolit ve hormonlardaki değişimi değerlendiren yeterli çalışma yoktur. Çalışmamızın amacı serum kalsiyum (Ca), magnezyum (Mg), fosfor (P), 25-hidroksivitamin D (25(OH)D) ve paratiroid hormon (PTH) düzeylerindeki değişimler ile sepsisli hastalarda mortalite arasındaki ilişkiyi değerlendirmektir.
Gereç ve Yöntem: Çalışmamız Ekim 2017-Ocak 2019 tarihleri arasında yoğun bakım ünitesinde (YBÜ) yatan sepsisli hastalar üzerinde yapılmıştır. Kalsiyum, Mg, P, 25(OH)D ve PTH düzeyleri, demografik ve klinik özellikleri ile birlikte hayatta kalan ve ölen hastalar karşılaştırıldı.
Bulgular: Çalışmaya toplam 225 hasta alındı. 225 hastanın 94'ü (%41,2) öldü ve 131'i (%58,8) taburcu edildi. Ölen hastalarda hayatta kalan hastalardan, PTH ve P seviyeleri anlamlı derecede daha yüksek, 25(OH)D, Ca ve Mg seviyeleri ise anlamlı derecede daha düşük bulundu.
Sonuç: Sepsis sırasında hassas bir denge içinde olan Ca metabolizmasının hipokalsemi, hipomagnezemi, hiperfosfatemi, düşük 25(OH)D ve yüksek PTH yönünde değişmesi mortalite ile ilişkilendirildi.
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Affiliation(s)
- Esra YAKIŞIK ÇAKIR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ VE REANİMASYON ANABİLİM DALI
| | - Çiğdem YÜCEL
- GULHANE MILITARY ACADEMY OF MEDICINE, GÜLHANE MILITARY FACULTY OF MEDICINE
| | - Murat KIZILGÜN
- GULHANE MILITARY ACADEMY OF MEDICINE, GÜLHANE MILITARY FACULTY OF MEDICINE
| | - Işıl ÖZKOÇAK TURAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ VE REANİMASYON ANABİLİM DALI
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Prevalence of vitamin D deficiency and its prognostic impact on patients hospitalized with COVID-19. Nutrition 2021; 91-92:111408. [PMID: 34388589 PMCID: PMC8247197 DOI: 10.1016/j.nut.2021.111408] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023]
Abstract
Objectives: Although hypovitaminosis D appears to be highly prevalent in patients with coronavirus disease 2019 (COVID-19), its impact on their prognosis remains unclear. Methods: In this study, serum 25-hydroxyvitamin D (Vit-D) level was measured in 200 patients hospitalized with COVID-19. The association between Vit-D and the composite endpoint of intensive care unit (ICU) admission/in-hospital death was explored using univariable and multivariable analyses. Also, serum Vit-D level in patients with COVID-19 was compared with that in age- and sex-balanced COVID-19-negative controls (i.e., 50 inpatients with sepsis). Results: Serum Vit-D level was comparable between patients with COVID-19 and COVID-19-negative inpatients with sepsis (P = 0.397). No significant differences were found in serum Vit-D level according to COVID-19 severity at the time of hospital admission (P = 0.299). Incidence rates of the composite endpoint of ICU admission/in-hospital death did not differ significantly between patients with either Vit-D deficiency (i.e., Vit-D <20 ng/mL) or severe Vit-D deficiency (i.e., Vit-D <12 ng/mL) and those without (31% vs 35% with P = 0.649, and 34% vs 30% with P = 0.593, respectively). Vit-D level and status (i.e., Vit-D deficiency and severe Vit-D deficiency) were not prospectively associated with the risk of the composite endpoint of ICU admission/in-hospital death (P > 0.05 for all Cox regression models). Conclusions: Regardless of the potential usefulness of Vit-D measurement to guide appropriate supplementation, Vit-D does not appear to provide helpful information for the stratification of in-hospital prognosis in patients with COVID-19.
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Vitamin D: A magic bullet or a myth? Clin Nutr 2020; 39:2663-2674. [DOI: 10.1016/j.clnu.2019.12.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 02/08/2023]
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Eslamian G, Ardehali SH, Hajimohammadebrahim-Ketabforoush M, Vahdat Shariatpanahi Z. Association of intestinal permeability with admission vitamin D deficiency in patients who are critically ill. J Investig Med 2019; 68:397-402. [PMID: 31672717 DOI: 10.1136/jim-2019-001132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2019] [Indexed: 12/14/2022]
Abstract
Emerging data have led to the hypothesis that vitamin D plays a role in promoting epithelial barrier dysfunction. Therefore, intestinal permeability becomes a significant determiner in the future of patients hospitalized in intensive care unit (ICU). The relationship between vitamin D and intestinal permeability remains unclear in patients who are critically ill. The aim of the study is to document the relationship between the admission vitamin D deficiency and markers of intestinal permeability in the critical care setting. This was a single-center, observational, prospective study in the general ICU of a university-affiliated hospital. A sample of 144 ICU-hospitalized adult patients was recruited between January and May 2018. The admission serum 25-hydroxyvitamin D levels were measured and categorized as <20 and ≥20 ng/dL, respectively. Moreover, the admission plasma endotoxin and zonulin concentrations as markers of intestinal permeability were determined in stringent conditions. The association between markers of intestinal permeability and 25-hydroxyvitamin D levels was assessed adjusting for potential confounders through an estimation of a binary logistic regression model. Our results showed that median plasma endotoxin and zonulin decreased with increasing serum levels of vitamin D categories (p=0.001) in the overall study population. Multivariate binary logistic regression analyses showed a significant association between the plasma endotoxin (OR 0.12, 95% CI 0.03 to 0.52) and zonulin (OR 0.91, 95% CI 0.87 to 0.99) levels with serum levels of vitamin D categories in the overall population. Our finding suggests a relationship between vitamin D deficiency and early alterations in intestinal permeability. Thus, evaluating vitamin D levels in patients who are critically ill may be warranted.
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Affiliation(s)
- Ghazaleh Eslamian
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ardehali
- Department of Anesthesiology and Critical Care, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Melika Hajimohammadebrahim-Ketabforoush
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Serum Admission 25-Hydroxyvitamin D Levels and Outcomes in Initially Non-Septic Critically Ill Patients. Shock 2019; 50:511-518. [PMID: 29337839 DOI: 10.1097/shk.0000000000001105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To examine whether very low levels of 25-hydroxyvitamin D {25(OH)D} upon admission to the intensive care unit (ICU) are associated with worse outcomes. METHODS Retrospective observational cohort study of critically ill patients treated in a multidisciplinary ICU. Two hundred twenty seven initially non-septic, critically ill patients, in whom 25-hydroxyvitamin D was measured at ICU admission. An additional group of 192 healthy subjects was also used. Patients were categorized according to their vitamin D levels at admission; the two patient groups were those with severely low 25-hydroxyvitamin D levels (<7 ng/mL, N = 101) and those with vitamin D levels ≥7 ng/mL, N = 126. RESULTS ICU admission 25-hydroxyvitamin D levels of critically ill patients were much lower than those of healthy subjects (P < 0.0001). The median time to sepsis for the two patient groups did not differ, nor did the length of ICU stay (days). Both groups exhibited similar hospital mortality rates. However, among the fraction of patients who eventually became septic (N = 145), the odds ratio (OR) for developing respiratory infections in patients with admission vitamin levels < 7 ng/mL compared with patients with admission vitamin D levels ≥7 ng/mL was 5.25 {95% confidence interval (CI) 1.5-18.32, P = 0.009}. CONCLUSIONS Initially non-septic critically ill patients appear to have very low ICU admission 25-hydroxyvitamin D levels. Among critically ill patients, severely low vitamin D levels (<7 ng/mL) at ICU admission do not predict sepsis development, increased risk of in-hospital mortality, or longer stay in the ICU. However, these severely low admission vitamin D levels in patients who will eventually develop sepsis are associated with development of respiratory tract infections.
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Franzke B, Schober-Halper B, Hofmann M, Oesen S, Tosevska A, Strasser EM, Marculescu R, Wessner B, Wagner KH. Fat Soluble Vitamins in Institutionalized Elderly and the Effect of Exercise, Nutrition and Cognitive Training on Their Status-The Vienna Active Aging Study (VAAS): A Randomized Controlled Trial. Nutrients 2019; 11:nu11061333. [PMID: 31197107 PMCID: PMC6627161 DOI: 10.3390/nu11061333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Institutionalized elderly are at higher risk for micronutrient deficiency. In particular, fat soluble micronutrients, which additionally have antioxidative function, are of interest. The purpose of this secondary investigation of the Vienna Active Ageing Study was to assess and evaluate the plasma status of retinol, alpha- and gamma-tocopherol, alpha- and beta-carotene, lutein, zeaxanthin, beta-cryptoxanthin, and lycopene, as well as vitamin D (25(OH)D) in a cohort of institutionalized elderly. We further determined the effect of six months strength training with or without supplementing (antioxidant) vitamins and protein on the plasma status of these ten micronutrients. METHODS Three groups (n = 117, age = 83.1 ± 6.1 years)-resistance training (RT), RT combined with protein and vitamin supplementation (RTS), or cognitive training (CT)-performed two guided training sessions per week for six months. Micronutrients were measured with High Performance Liquid Chromatography (HPLC) at baseline and after 6 months of intervention. Physical fitness was assessed by the 6-min-walking, the 30-s chair rise, isokinetic dynamometry, and the handgrip strength tests. RESULTS At baseline, the plasma status of retinol was satisfactory, for alpha-tocopherol, beta-carotene, and 25(OH)D, the percentage of individuals with an insufficient status was 33%, 73% and 61%/81% (when using 50 nmol/L or 75 nmol/L as threshold levels for 25(OH)D), respectively. Plasma analyses were supported by intake data. Six months of elastic band resistance training with or without protein-vitamin supplementation had no biological impact on the status of fat soluble micronutrients. Even for vitamin D, which was part of the nutritional supplement (additional 20 µg/d), the plasma status did not increase significantly, however it contributed to a lower percentage of elderly below the threshold levels of 50/75 nmol/L (49%/74%). CONCLUSIONS The findings of the study lead to the strong recommendation for regular physical activity and increased consumption of plant-based foods in institutionalized elderly. When supported by blood analysis, supplementing micronutrients in a moderate range should also be considered.
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Affiliation(s)
- Bernhard Franzke
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
| | - Barbara Schober-Halper
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
- Centre for Sport Science and University Sports, Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria.
| | - Marlene Hofmann
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
- Centre for Sport Science and University Sports, Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria.
| | - Stefan Oesen
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
- Centre for Sport Science and University Sports, Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria.
| | - Anela Tosevska
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
- Department of Molecular, Cell and Developmental Biology, UCLA, 610 Charles E. Young Drive East, Los Angeles, CA 90095, USA.
| | - Eva-Maria Strasser
- Karl Landsteiner Institute for Remobilization and Functional Health/Institute for Physical Medicine and Rehabilitation, Kaiser Franz Joseph Spital, SMZ-Süd, Kundratstraße 3, 1100 Vienna, Austria.
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Division of Medical-Chemical Laboratory Diagnostics, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
| | - Barbara Wessner
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
- Centre for Sport Science and University Sports, Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria.
| | - Karl-Heinz Wagner
- Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
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Prevalence and Outcome of Secondary Hemophagocytic Lymphohistiocytosis Among SIRS Patients: Results from a Prospective Cohort Study. J Clin Med 2019; 8:jcm8040541. [PMID: 31010216 PMCID: PMC6518152 DOI: 10.3390/jcm8040541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022] Open
Abstract
Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening condition clinically presenting as SIRS (Systemic Inflammatory Response Syndrome). However, there is no comprehensive data concerning diagnostic algorithms, prevalence, outcome and biomarker performance in SIRS patients. We conducted a prospective observational cohort study on 451 consecutive patients fulfilling ≥2 SIRS criteria. The Hscore and the HLH-2004 criteria were used to determine the presence of sHLH, and the correlation of the screening-biomarkers ferritin, sCD25, and sCD163 with both scores was assessed. Out of 451 standard-care SIRS patients, five patients had high Hscores (≥169), suggesting incipient or HLH-like disease, and these patients were in urgent need for intensified therapy. However, none of these patients fulfilled five HLH-2004 criteria required for formal diagnosis. From the studied biomarkers, ferritin correlated strongest to both the HLH-2004 criteria and the Hscore (rs = 0.72, 0.41, respectively), and was the best predictor of 30-day survival (HR:1.012 per 100 μg/L, 95% CI: 1.004-1.021), when adjusted for patient's age, sex, bacteremia and malignant underlying-disease. Also, the HLH-2004 (HR per point increase: 1.435, 95% CI: 1.1012-2.086) and the Hscore (HR per point increase:1.011, 95% CI: 1.002-1.020) were independent predictors of 30-day-survival. The Hscore detected patients in hyperinflammatory states requiring urgent therapy escalation. Degrees of hyperinflammation, as assessed by ferritin and both HLH scores, are associated with worse outcomes.
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14
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Kanatani KT, Adachi Y, Hamazaki K, Onishi K, Go T, Hirabayashi K, Watanabe M, Sato K, Kurozawa Y, Inadera H, Oyama H, Nakayama T. Association between vitamin D deficiency and allergic symptom in pregnant women. PLoS One 2019; 14:e0214797. [PMID: 30969993 PMCID: PMC6457537 DOI: 10.1371/journal.pone.0214797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/20/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Vitamin D has been reported to affect both innate, and acquired immunity with immune cells such as dendritic cells having the vitamin D receptors. The co-occurrence of the high prevalence of allergic diseases and vitamin D deficiency globally documented in recent decades, has prompted a hypothesis on whether there is a reasonable association between them. OBJECTIVE To investigate the association between serum vitamin D deficiency and allergic symptoms. METHODS Historical cohort. On a cohort study for the association between desert dust exposure and allergic symptoms in 3,327 pregnant women during spring and fall in 2011-2013 in Japan conducted as an adjunct study to the Japan Environment and Children's Study, we promptly acquired subjects' daily allergic symptom scores by sending a web-based questionnaire to each participant on some days. Of the 29,434 answers provided by 3,327 participating pregnant women, we extracted 13,356 answers from 1,475 pregnant women that were answered within a 3-month period after blood samplings. And we measured 25(OH)D levels on those samples to investigate the association between their vitamin D deficiency (serum 25(OH)D < 20ng/mL) and the occurrence of any allergic symptom (allergic symptom score> 0) within 3 months. RESULTS Serum 25(OH)D was less than 20ng/mL in 1,233 of 1,745 samples (70.7%). The adjusted odds ratio (aOR) for occurrence of any allergic symptom in deficient cases compared with non-deficient cases was 1.33 (95% CI: 1.07-1.64, p = 0.01). Further, vitamin D deficiency significantly enhanced the risk increase at desert dust events and at pollen exposure (p-values for interaction <0.1). CONCLUSION We confirmed the association between serum vitamin D deficiency and allergic symptoms in Japanese pregnant women.
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Affiliation(s)
- Kumiko T. Kanatani
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Kyoto Unit Centre for Japan Environment and Children’s Study, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kei Hamazaki
- Department of Public Health, University of Toyama, Toyama, Japan
| | - Kazunari Onishi
- Department of Public Health, Tottori University, Yonago, Tottori, Japan
| | - Tohshin Go
- Kyoto Unit Centre for Japan Environment and Children’s Study, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyoko Hirabayashi
- Kyoto Unit Centre for Japan Environment and Children’s Study, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Keiko Sato
- Kyoto Unit Centre for Japan Environment and Children’s Study, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Youichi Kurozawa
- Department of Public Health, Tottori University, Yonago, Tottori, Japan
| | - Hidekuni Inadera
- Department of Public Health, University of Toyama, Toyama, Japan
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Health Services Sciences, School of Public Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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Vitamin D status and its influence on outcomes following major burn injury and critical illness. BURNS & TRAUMA 2018; 6:11. [PMID: 29721511 PMCID: PMC5910591 DOI: 10.1186/s41038-018-0113-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/23/2018] [Indexed: 12/11/2022]
Abstract
Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients. Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overlooked by medical staff as the clinical implications and consequences of vitamin D deficiency in acute contexts remain to be fully understood. Vitamin D has a broad range of pleotropic effects on various processes and systems including the immune-inflammatory response. 1α,25-dihydroxyvitamin D (1,25(OH)2D), has been shown to promote a tolerogenic immune response limiting deleterious inflammatory effects, modulation of the innate immune system, and enhancement of anti-microbial peptides. Vitamin D deficiency is frequently observed in critically ill patients and has been related to extrinsic causes (i.e., limited sunlight exposure), magnitude of injury/illness, or the treatment started by medical doctors including fluid resuscitation. Low levels of vitamin D in critically ill patients have been associated with sepsis, organ failure, and mortality. Despite this, there are subpopulations of critical illness, such as burn patients, where the literature regarding vitamin D status and its influence on outcomes remain insufficient. Thermal injury results in damage to both burned and non-burned tissues, as well as induces an exaggerated and persistent immune-inflammatory and hypermetabolic response. In this review, we propose potential mechanisms in which burn injury affects the vitamin D status and summarizes current literature investigating the influence of vitamin D status on outcomes. In addition, we reviewed the literature and trials investigating vitamin D supplementation in critically ill patients and discuss the therapeutic potential of vitamin D supplementation in burn and critically ill patients. We also highlight current limitations of studies that have investigated vitamin D status and supplementation in critical illness. Thermal injury influences vitamin D status. More studies investigating vitamin D depletion in burn patients and its influence on prognosis, via standardized methodology, are required to reach definitive conclusions and influence clinical practice.
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Gamal TS, Madiha AAS, Hanan MK, Abdel-Azeem MEM, Marian GS. Neonatal and Maternal 25-OH Vitamin D Serum Levels in Neonates with Early-Onset Sepsis. CHILDREN-BASEL 2017; 4:children4050037. [PMID: 28486434 PMCID: PMC5447995 DOI: 10.3390/children4050037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/22/2017] [Accepted: 05/02/2017] [Indexed: 12/14/2022]
Abstract
Vitamin D is a fat-soluble vitamin that is important for calcium metabolism and plays an important role in the immune functions. The aim of this study was to measure neonatal and maternal 25-OH vitamin D serum levels in neonates with early onset sepsis. The study included fifty neonates with early onset sepsis (25 full-term and 25 preterm infants) and thirty age and sex matched healthy neonates as controls. After history taking and clinical examination, complete blood count, C-reactive protein and 25-OH vitamin D serum levels (neonatal and maternal) were measured for all neonates. The mean gestational age for neonates with sepsis was (37.5 ± 0.98 for full term and 34.1 ± 1.26 for preterm neonates). Neonatal and maternal 25-OH vitamin D serum levels were significantly lower in patients (6.4 ± 1.8 and 24.6 ± 2.2 nmol/L) than controls (42.5 ± 20.7 and 50.4 ± 21.4 nmol/L). Significant negative correlations between neonatal and maternal 25-OH vitamin D serum levels and all sepsis markers and significant positive correlations between neonatal and maternal 25-OH vitamin D levels were present. At cut-off values <20 nmol/L for neonatal and <42 nmol/L for maternal 25-OH vitamin D for detection of neonatal sepsis, the sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV) were 84%, 79%, 94.7% and 82.3% for neonatal and 82%, 77%, 91.4% and 80.6% for maternal 25-OH vitamin D, respectively. Positive correlations between neonatal and maternal 25-OH Vitamin D serum levels are present and they are negatively correlated with all sepsis markers. They can be sensitive early predictors for early onset sepsis in neonates.
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Affiliation(s)
| | | | | | | | - Gamil S Marian
- Pediatric Department, El-Minya University, Minya, 11432, Egypt.
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