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Critical Care |

Vitamin D as a Predictor for Sepsis in the Medical ICU

Jordan Kempker*, MD; Thomas Ziegler, MD; Vin Tangpricha, MD; David Guidot, MD; Greg Martin, MD
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Emory School of Medicine, Atlanta, GA


Chest. 2012;142(4_MeetingAbstracts):379A. doi:10.1378/chest.1389879
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Abstract

SESSION TYPE: ICU Safety and Quality Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Recent evidence is revealing that vitamin D has an important role in the function of the innate immune system. The purpose of this study is to determine whether serum 25-hydroxyvitamin D (25(OH)D) concentration at the time of admission to the medical ICU is a predictor of sepsis.

METHODS: This is a prospective observational study of all admissions to the medical ICU at Grady Memorial Hospital (Atlanta, GA) from November 11, 2011 to March 8, 2012. We excluded those < 18 years of age and those with an anticipated ICU stay < 1 day. Clinical data was collected from the electronic medical record and phlebotomy was performed on all patients with informed consent. Serum 25(OH)D was assayed using an automated chemiluminescent technique.

RESULTS: Eighty-one patients with serum 25(OH)D measurements were included in the study. The group was predominantly black (82.7%), with 53.1% being male, median age of 56 (IQR 48-68) years and median APACHE II score of 23 (IQR 17-28). Forty-one patients (50.6%) met sepsis criteria and 17 (41.5%) of these had septic shock. Median serum 25(OH)D concentration was 11.9 ng/mL (IQR 7.3-17.3 ng/mL) with 31 (38.3%) < 10 ng/mL, 36 (44.4%) at 10-19 ng/mL, 8 (9.9 %) at 20-29 ng/mL and 6 (7.4%) ≥ 30 ng/mL. Serum 25(OH)D concentrations were similar among those with and without sepsis (13.0 ng/mL and 13.9 ng/mL respectively, p=0.70). Among those with sepsis, 25(OH)D concentration was non-significantly lower among those with shock (10.8 ng/mL vs. 14.6 ng/mL, p=0.30).

CONCLUSIONS: Serum 25(OH)D concentrations were universally low in this sample of adult medical ICU patients, yet were not different among those with sepsis compared to those without sepsis.

CLINICAL IMPLICATIONS: Vitamin D deficiency is highly prevalent in medical ICU patients but its relationship to sepsis and clinical outcomes, or whether replacement may be beneficial, remains to be determined.The role of vitamin D as a risk factor or marker for sepsis is unclear but it may be an important health intervention in adult medical ICU.

DISCLOSURE: The following authors have nothing to disclose: Jordan Kempker, Thomas Ziegler, Vin Tangpricha, David Guidot, Greg Martin

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Emory School of Medicine, Atlanta, GA

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