Estatus nutricional de la vitamina d y metabolismo fosfocálcico en la sepsis relación del metabolismo de la vitamina d con la inflamación en la sepsis

Abstract

Vitamin D could play an important role in the regulation of inflammation and protection against infection, inducing the synthesis of antimicrobial peptides. Vitamin D deficiency was associated with increased mortality rates in septic adult patients. Vitamin D binding protein (VDBP) also has anti-inflammatory and immunomodulatory functions. The aim of this study was to evaluate the levels of total and free 25-hydroxyvitamin D (25(OH) D), on admission to the ICU of a group of critically ill patients with septic shock and to relate them to inflammatory, phospho-calcium metabolism and clinical evaluation parameters and whether Vitamin D or related parameters are involved in the evolution, prognosis and survival of these patients. This is a single-center, prospective, observational study that included 75 consecutive patients meeting criteria for septic shock who were admitted to the ICU. 25(OH) D, 1,25(OH)2 D, VDBP, cathelicidin, β-2-defensin, C reactive protein (CRP), procalcitonin (PCT), pentraxin 3 (PTX3) and lactate levels were determined in blood samples obtained in admission to the ICU and related to clinical parameters. The best area under the curve for prediction of in-hospital mortality was for the VDBP. Our results support that low serum VDBP levels had a statistically significant association with in-hospital mortality. No differences were found for in-hospital mortality according to the levels of the rest of parameters. In addition, VDBP showed a statistically significant association with global, 30-day and 90-mortality. According to ROC curve, PTX3 could be a potential predictor of hospital mortality in septic shock patients, higher than the AUC for PCT and CRP but lower than the AUC for VDBP and lactate.