25-hydroxyvitamin D and Parathyroid Hormone in New Onset Sepsis: A Prospective Study in Critically Ill Patients

Overview

Journal Metabol Open

Specialty Endocrinology

Date 2024 Jul 10

PMID 38983450

Authors

Irene Karampela

Theodora Stratigou

Georgios Antonakos

Dimitris Kounatidis

Natalia G Vallianou

Dimitrios Tsilingiris

Maria Dalamaga

Affiliations

Soon will be listed here.

Abstract

Hypovitaminosis D is highly prevalent in critically ill patients, and it has been suggested to be a risk factor for infections, sepsis and higher mortality. We sought to investigate whether serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) in critically ill patients with new onset sepsis are associated with severity and outcome. We prospectively included 50 consecutive critically ill adult cases with new onset sepsis and 50 healthy controls matched for age and sex. PTH and 25(OH)D were determined in serum via electrochemiluminescence immunoassays at inclusion in the study in all cases and controls, and one week after sepsis onset in cases. Patients had reduced 25(OH)D compared to controls at sepsis onset (7.9 ± 3 vs 24.6 ± 6.7 ng/mL, p < 0.001), whilst PTH was similar (median (range): 34.5 (5.7-218.5) vs 44.2 (14.2-98.1) pg/mL, p = 0.35). In patients, 25(OH)D upon enrollment and one week after did not differ significantly (7.9 ± 3 vs 7 ± 4.3 ng/mL, p = 0.19). All patients presented with hypovitaminosis D (25(OH)D < 20 ng/mL), while 40 patients (80 %) had vitamin D deficiency (25(OH)D < 12 ng/mL) at sepsis onset, including all ten (20 %) nonsurvivors, who died within 28 days from sepsis onset. Patients with sepsis (N = 28) and septic shock (N = 22) as well as survivors (N = 40) and nonsurvivors (N = 10) had similar 25(OH)D at enrollment (p > 0.05). 25(OH)D was positively correlated with ionized calcium (r = 0.46, p < 0.001) and negatively with PTH (p < 0.05), while inflammatory biomarkers or the severity scores exhibited no correlation with 25(OH)D. Patients with septic shock and nonsurvivors had lower PTH than patients with sepsis and survivors respectively (42.2 ± 42.9 vs 73.4 ± 61.9 pg/mL, p = 0.04, and 18.3 ± 10.7 vs 69.9 ± 58.8 pg/mL, p = 0.001, respectively). C-reactive protein was negatively associated with PTH (r = -0.44, p = 0.001). In conclusion, vitamin D deficiency was present in 80 % of critically ill patients at sepsis onset, while nonsurvivors exhibited lower PTH than survivors. Additional, larger and multicenter studies are warranted to elucidate the contribution of vitamin D and PTH to the pathogenesis of sepsis and its outcomes.

Citing Articles

Ethnic differences in vitamin D status, bone and body composition in South Asian indian and caucasian men.

Altasan A, Aljahdali A, Ramadoss R, Cheung M, Dall R, Bruneau Jr M Metabol Open. 2024; 23:100302.

PMID: 39161755 PMC: 11331910. DOI: 10.1016/j.metop.2024.100302.

References

Jovanovich A, Ginde A, Holmen J, Jablonski K, Allyn R, Kendrick J . Vitamin D level and risk of community-acquired pneumonia and sepsis. Nutrients. 2014; 6(6):2196-205. PMC: 4073143. DOI: 10.3390/nu6062196. View

Dalamaga M, Karmaniolas K, Papadavid E, Pelekanos N, Sotiropoulos G, Lekka A . Hyperresistinemia is associated with postmenopausal breast cancer. Menopause. 2013; 20(8):845-51. DOI: 10.1097/GME.0b013e31827f06dc. View

Czarnik A, Gawda R, Piwoda M, Marszalski M, Molsa M, Pietka M . Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study. Endokrynol Pol. 2021; 72(4):329-335. DOI: 10.5603/EP.a2021.0034. View

Colotta F, Jansson B, Bonelli F . Modulation of inflammatory and immune responses by vitamin D. J Autoimmun. 2017; 85:78-97. DOI: 10.1016/j.jaut.2017.07.007. View

Klein G, Castro S, Garofalo R . The calcium-sensing receptor as a mediator of inflammation. Semin Cell Dev Biol. 2015; 49:52-6. PMC: 4761504. DOI: 10.1016/j.semcdb.2015.08.006. View

Upala S, Sanguankeo A, Permpalung N . Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis. BMC Anesthesiol. 2015; 15:84. PMC: 4455341. DOI: 10.1186/s12871-015-0063-3. View

Dalamaga M, Karmaniolas K, Arsenis G, Pantelaki M, Daskalopoulou K, Papadavid E . Cedecea lapagei bacteremia following cement-related chemical burn injury. Burns. 2008; 34(8):1205-7. DOI: 10.1016/j.burns.2007.09.001. View

Park J, Pichiah P, Cha Y . Vitamin D and Metabolic Diseases: Growing Roles of Vitamin D. J Obes Metab Syndr. 2019; 27(4):223-232. PMC: 6513299. DOI: 10.7570/jomes.2018.27.4.223. View

Papadavid E, Gazi S, Dalamaga M, Stavrianeas N, Ntelis V . Palmoplantar and scalp psoriasis occurring during anti-tumour necrosis factor-alpha therapy: a case series of four patients and guidelines for management. J Eur Acad Dermatol Venereol. 2008; 22(3):380-2. DOI: 10.1111/j.1468-3083.2007.02335.x. View

10.

Lange N, Litonjua A, Gibbons F, Giovannucci E, Christopher K . Pre-hospital vitamin D concentration, mortality, and bloodstream infection in a hospitalized patient population. Am J Med. 2013; 126(7):640.e19-27. DOI: 10.1016/j.amjmed.2012.12.014. View

11.

Karampela I, Vallianou N, Tsilingiris D, Christodoulatos G, Psallida S, Kounatidis D . Alterations of the Adipo-Myokine Irisin in Sepsis and Septic Shock: Diagnostic and Prognostic Implications. Biomolecules. 2024; 14(3). PMC: 10968263. DOI: 10.3390/biom14030291. View

12.

Nair P, Venkatesh B, Center J . Vitamin D deficiency and supplementation in critical illness-the known knowns and known unknowns. Crit Care. 2018; 22(1):276. PMC: 6205786. DOI: 10.1186/s13054-018-2185-8. View

13.

Pinheiro da Silva F, Zampieri F, Barbeiro H, Torggler Filho F, Goulart A, Jorgetti V . Decreased parathyroid hormone levels despite persistent hypocalcemia in patients with kidney failure recovering from septic shock. Endocr Metab Immune Disord Drug Targets. 2012; 13(2):135-42. DOI: 10.2174/1871530311313020001. View

14.

Karampela I, Chrysanthopoulou E, Skyllas G, Christodoulatos G, Kandri E, Antonakos G . Circulating leptin, soluble leptin receptor and free leptin index in critically ill patients with sepsis: a prospective observational study. Minerva Anestesiol. 2021; 87(8):880-890. DOI: 10.23736/S0375-9393.21.15368-4. View

15.

Dalamaga M, Muscogiuri G, Paganitsa G, Parvouleskou G, Syriou V, Karagkoynis P . Adherence to the Mediterranean diet is an independent predictor of circulating vitamin D levels in normal weight and non-smoker adults: an observational cross-sectional study. Int J Food Sci Nutr. 2021; 72(6):848-860. DOI: 10.1080/09637486.2021.1878488. View

16.

Kubsad P, Ravikiran S, Bhat K, Kamath N, Kulkarni V, Manjrekar P . Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study. Indian J Crit Care Med. 2021; 25(8):923-927. PMC: 8559742. DOI: 10.5005/jp-journals-10071-23913. View

17.

Lang P, Aspinall R . Vitamin D Status and the Host Resistance to Infections: What It Is Currently (Not) Understood. Clin Ther. 2017; 39(5):930-945. DOI: 10.1016/j.clinthera.2017.04.004. View

18.

Dalamaga M, Karmaniolas K, Chamberland J, Nikolaidou A, Lekka A, Dionyssiou-Asteriou A . Higher fetuin-A, lower adiponectin and free leptin levels mediate effects of excess body weight on insulin resistance and risk for myelodysplastic syndrome. Metabolism. 2013; 62(12):1830-9. DOI: 10.1016/j.metabol.2013.09.007. View

19.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

20.

Lind L, Carlstedt F, Rastad J, Stiernstrom H, Stridsberg M, Ljunggren O . Hypocalcemia and parathyroid hormone secretion in critically ill patients. Crit Care Med. 2000; 28(1):93-9. DOI: 10.1097/00003246-200001000-00015. View