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Vitamin D reduces sepsis


Summary of Sepsis and Vitamin D

  • Sepsis more likely in those with poor immune systems
    Infants, elderly, sick, those with low vitamin D
  • Severe Sepsis has been associated with low vitamin D in many studies
  • Vitamin D treats Sepsis (RCT- 2015, below)
    Reduced: ICU by 8 days, Hospital stay by 7 days, and readmission rate 0% (from 20%)
  • Many studies have found that a high level of Vitamin D also prevents Sepsis

VitaminDWiki recommendations for Vitamin D treatment of Sepsis in ICU


200,000 and 400,000 IU of vitamin D reduced septic shock, length of stay - RCT June 2015

Effect of Cholecalciferol Supplementation on Vitamin D Status and Cathelicidin Levels in Sepsis: A Randomized, Placebo-Controlled Trial.
Critical Care Medicine:, Post Author Corrections: June 17, 2015, doi: 10.1097/CCM.0000000000001148
Quraishi, Sadeq A. MD, MHA, MMSc; De Pascale, Gennaro MD; Needleman, Joseph S. BS, BA; Nakazawa, Harumasa MD, PhD; Kaneki, Masao MD, PhD; Bajwa, Ednan K. MD, MPH; Camargo, Carlos A. Jr MD, DrPH; Bhan, Ishir MD, MPH
Quraishi, Sadeq A., MD SQURAISHI at PARTNERS.ORG

Placebo 200,000 IU400,000 IUp
ICU LOS 12 days 4 days 3 days0.83
Hospital LOS 21 days 13 days 14 days 0.03
30 day readmission 20%0%0%< 0.001
30 day still alive 70%70%80% 0.18

Objectives: To compare changes in vitamin D status and cathelicidin (LL-37) levels in septic ICU patients treated with placebo versus cholecalciferol.
Design: Randomized, placebo-controlled, trial.
Setting: Medical and surgical ICUs of a single teaching hospital in Boston, MA.
Patients: Thirty adult ICU patients.
Interventions: Placebo (n = 10) versus 200,000 IU cholecalciferol (n = 10) versus 400,000 IU cholecalciferol (n = 10), within 24 hours of new-onset severe sepsis or septic shock.

Measurements and Main Results: Blood samples were obtained at baseline (day 1) and on days 3, 5, and 7, to assess total 25-hydroxyvitamin D, as well as vitamin D-binding protein and albumin to calculate bioavailable 25-hydroxyvitamin D. Plasma LL-37 and high-sensitivity C-reactive protein levels were also measured. At baseline, median (interquartile range) plasma 25-hydroxyvitamin D was 17 ng/mL (13-22 ng/mL) and peaked by day 5 in both intervention groups.
Groups were compared using Kruskal-Wallis tests. Relative to baseline, on day 5, median change in biomarkers for
placebo,
200,000 IU cholecalciferol, and
400,000 IU cholecalciferol groups, respectively,
were as follows:

  • 1) total 25-hydroxyvitamin D, 3% (-3% to 8%), 49% (30-82%), and 69% (55-106%) (p < 0.001);
  • 2) bioavailable 25-hydroxyvitamin D, 4% (-8% to 7%), 45% (40-70%), and 96% (58-136%) (p < 0.01); and
  • 3) LL-37: -17% (-9% to -23%), 4% (-10% to 14%), and 30% (23-48%) (p = 0.04).
    Change in high-sensitivity C-reactive protein levels did not differ between groups.

A positive correlation was observed between bioavailable 25-hydroxyvitamin D and LL-37 (Spearman [rho] = 0.44; p = 0.03) but not for total 25-hydroxyvitamin D and LL-37.

Conclusions: High-dose cholecalciferol supplementation rapidly and safely improves 25-hydroxyvitamin D and bioavailable 25-hydroxyvitamin D levels in patients with severe sepsis or septic shock. Changes in bioavailable 25-hydroxyvitamin D are associated with concomitant increases in circulating LL-37 levels. Larger trials are needed to verify these findings and to assess whether optimizing vitamin D status improves sepsis-related clinical outcomes.

 Download the PDF from VitaminDWiki

Notes by VitaminDWiki
  1. Dr. Quraishi has another another Clinical Trial using 400,000 IU followed by 25,000 IU weekly - due 2022
  2. Dr. Quraishi has co-authored a chapter Vitamin D, Hospital-Acquired Infections and Mortality in Critically Ill Patients: Emerging Evidence
    Publisher wants $31 for the chapter, references, however, are free
  3. LL-37 is an antimicrobial peptide - click to see full image
    Image
  4. 400,000 IU increases vitamin D levels by >40 ng in healthy individuals in a few days
    But Vitamin D levels increased only about 15 ng for those with sepsis
    Image
    Suspect those with Sepsis need more than 400,000 IU
  5. Injection should also be considered - as it totally skips over any digestion problems which might be associated with Sepsis
  6. See also: Overview Loading of vitamin D, which is widely used to improve ICU outcomes

2.9 X more likely to recover from Septic Shock in 24 hours if have higher level of vitamin D (> 10 ng?) - 2017

Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock.
J Intensive Care Med. 2017 Jan 1:885066617699802. doi: 10.1177/0885066617699802. [Epub ahead of print]

OBJECTIVES:
To evaluate the association of severe vitamin D deficiency with clinically important outcomes in children with septic shock.
METHODS:
We enrolled children ≤17 years with septic shock prospectively over a period of 6 months. We estimated 25-hydroxyvitamin D 25 (OH) D levels at admission and 72 hours. Severe deficiency was defined as serum 25 (OH) <10 ng/mL. We performed univariate and multivariate analysis to evaluate association with clinically important outcomes.
RESULTS:
Forty-three children were enrolled in the study. The prevalence of severe vitamin D deficiency was 72% and 69% at admission and 72 hours, respectively. On univariate analysis, severe vitamin D deficiency at admission was associated with lower rates of shock reversal, 74% (23) versus 25% (3); relative risk (95% confidence interval CI): 2.9 (1.09-8.08), at 24 hours and greater need for fluid boluses (75 vs 59 mL/kg).
On multivariate analysis, nonresolution of shock at 24 hours was significantly associated with severe vitamin D deficiency after adjusting for other key baseline and clinical variables, adjusted odds ratio (95% CI): 12 (2.01-87.01); 0.01.
CONCLUSION:
The prevalence of severe vitamin D deficiency is high in children with septic shock admitted to pediatric intensive care unit. Severe vitamin D deficiency at admission seems to be associated with lower rates of shock reversal at 24 hours of ICU stay. Our study provides preliminary data for planning interventional studies in children with septic shock and severe vitamin D deficiency.

PMID: 28335672 DOI: 10.1177/0885066617699802 Publisher wants $40 for the PDF, but provides references for free


Two Meta-analyses of ICU and Vitamin D - April and May 2017

Both meta-analyses looked at Quraishi 2015 (at the top of this page and Amrein 2014, which follows


High dose + maint. dose Vitamin D reduce mortality – large RCT Amrein 2014

Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial.
JAMA. 2014 Oct 15;312(15):1520-30. doi: 10.1001/jama.2014.13204.
Amrein K1, Schnedl C1, Holl A2, Riedl R3, Christopher KB4, Pachler C5, Urbanic Purkart T6, Waltensdorfer A5, Münch A5, Warnkross H1, Stojakovic T7, Bisping E8, Toller W5, Smolle KH9, Berghold A3, Pieber TR1, Dobnig H10.


Image Image

IMPORTANCE:
Low vitamin D status is linked to increased mortality and morbidity in patients who are critically ill. It is unknown if this association is causal.
OBJECTIVE:
To investigate whether a vitamin D3 treatment regimen intended to restore and maintain normal vitamin D status over 6 months is of health benefit for patients in ICUs.
DESIGN, SETTING, AND PARTICIPANTS:
A randomized double-blind, placebo-controlled, single-center trial, conducted from May 2010 through September 2012 at 5 ICUs that included a medical and surgical population of 492 critically ill adult white patients with vitamin D deficiency (≤20 ng/mL) assigned to receive either vitamin D3 (n = 249) or a placebo (n = 243).
INTERVENTIONS:
Vitamin D3 or placebo was given orally or via nasogastric tube once at a dose of 540,000 IU followed by monthly maintenance doses of 90,000 IU for 5 months.
MAIN OUTCOMES AND MEASURES:
The primary outcome was hospital length of stay. Secondary outcomes included, among others, length of ICU stay, the percentage of patients with 25-hydroxyvitamin D levels higher than 30 ng/mL at day 7, hospital mortality, and 6-month mortality. A predefined severe vitamin D deficiency (≤12 ng/mL) subgroup analysis was specified before data unblinding and analysis.
RESULTS:
A total of 475 patients were included in the final analysis (237 in the vitamin D3 group and 238 in the placebo group). The median (IQR) length of hospital stay was not significantly different between groups (20.1 days [IQR, 11.1-33.3] for vitamin D3 vs 19.3 days [IQR, 11.1-34.9] for placebo; P = .98). Hospital mortality and 6-month mortality were also not significantly different (hospital mortality: 28.3% [95% CI, 22.6%-34.5%] for vitamin D3 vs 35.3% [95% CI, 29.2%-41.7%] for placebo; hazard ratio [HR], 0.81 [95% CI, 0.58-1.11]; P = .18; 6-month mortality: 35.0% [95% CI, 29.0%-41.5%] for vitamin D3 vs 42.9% [95% CI, 36.5%-49.4%] for placebo; HR, 0.78 [95% CI, 0.58-1.04]; P = .09). For the severe vitamin D deficiency subgroup analysis (n = 200), length of hospital stay was not significantly different between the 2 study groups: 20.1 days (IQR, 12.9-39.1) for vitamin D3 vs 19.0 days (IQR, 11.6-33.8) for placebo.
Hospital mortality was significantly lower with 28 deaths among 98 patients (28.6% [95% CI, 19.9%-38.6%]) for vitamin D3 compared with 47 deaths among 102 patients (46.1% [95% CI, 36.2%-56.2%]) for placebo (HR, 0.56 [95% CI, 0.35-0.90], P for interaction = .04), but not 6-month mortality (34.7% [95% CI, 25.4%-45.0%] for vitamin D3 vs 50.0% [95% CI, 39.9%-60.1%] for placebo; HR, 0.60 [95% CI, 0.39-0.93], P for interaction = .12).
CONCLUSIONS AND RELEVANCE:
Among critically ill patients with vitamin D deficiency, administration of high-dose vitamin D3 compared with placebo did not reduce hospital length of stay, hospital mortality, or 6-month mortality. Lower hospital mortality was observed in the severe vitamin D deficiency subgroup, but this finding should be considered hypothesis generating and requires further study.

clinicaltrials.gov Identifier: NCT01130181. PMID: 25268295 DOI: 10.1001/jama.2014.13204
 Download the PDF from VitaminDWiki


The only people who died of sepsis in the hospital were vitamin D deficient – April 2017

Correlation of serum vitamin D level with mortality in patients with sepsis
Indian Journal of Critical Care Magazine 2017 Vol 21, # 4, page : 199--204 DOI: 10.4103/ijccm.IJCCM_192_16
Prakash Vipul1, Consul Shuchi2, Agarwal Avinash1, Gutch Manish1, Kumar Sukriti1, Prakash Ved1
1 Department of Medicine, King George's Medical College, Lucknow, Uttar Pradesh, India
2 Department of OBG, King George's Medical College, Lucknow, Uttar Pradesh, India

Hospital Stay (Table 8)

Deficiency Insufficiency Normal
<7 days48 % 18 %34 %
7-14 days87 %7 %7 %
>14 days 73 %6 %21 %
Died 100 %0 %0%

Note by VitaminDWiki: Study does not seem to define the levels for Deficiency, etc.

Background: Sepsis is the leading cause of mortality in the critically ill. Recently, it has been found in many studies that many trace elements and nutrients do have an effect on human body and if supplemented can improve the prognosis in patients with sepsis.

Aim and Objectives: Primary objective: Whether low Vitamin D is associated with mortality. Secondary objective: To find out association of low Vitamin D levels and morbidity in terms of length of hospital and Intensive Care Unit (ICU) stay.

Subjects and Methods: Following ethical approval, consent will be sought from either the patient or assent from a near relative. Successive patients admitted to the medical emergency and ICU at tertiary care health center who fulfill the following criteria for sepsis, within a 24 h time window, were included in the study.

Results: Among 88 patients evaluated in our study 15 patients (18.2%) were found to have adequate Vitamin D levels and seven patients (8%) were found insufficient and rest 52 patients (73.9%) were found deficient in Vitamin D. Age of the patients ranged between 18 and 82 years with mean (±standard deviation) 45.02 ± 17.69 years. Mean Vitamin D level was found significantly higher among patients with positive outcome than those with unfavorable outcome (expiry) (t = 2.075, P = 0.04). On comparison of the length of hospital stay (morbidity) with Vitamin D levels, we found statistically significant inverse relation between Vitamin D levels and length of hospital stay.

Conclusion: Vitamin D deficiency leads to increased risk of mortality in the critically ill along with prolonged hospital stay.

 Download the PDF from VitaminDWiki


Infants with sepsis have very low Vitamin D levels – Aug 2014

Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants
Journal of Perinatology (2015) 35, 39-45;doi:10.1038/jp.2014.146; published online 7 August 2014
M Cetinkaya1, F Cekmez2, G Buyukkale1, T Erener-Ercan1, F Demir1, T Tunc2, FN Aydin3 and G Aydemir2
OBJECTIVE: To evaluate the effect of vitamin D levels on early-onset sepsis (EOS) in term infants.

STUDY DESIGN: Fifty term infants with clinical and laboratory findings of EOS (study group) and 50 healthy infants with no signs of clinical/laboratory infection (control group) were enrolled. Blood was drawn at the time of admission during the first 3 postnatal days of life in both groups for measurement of 25-hydroxyvitamin D (25-OHD) levels.

RESULT: Maternal and neonatal 25-OHD levels (22.2/8.6 ng ml-1, respectively) in the study group were significantly lower than those of the control group (36.2/19 ng ml-1, respectively, P < 0.001). A positive correlation was detected between maternal and neonatal 25-OHD levels. Severe vitamin D deficiency was significantly more common in the sepsis group.

CONCLUSION: Lower maternal and neonatal 25-OHD levels are associated with EOS. These data suggest that adequate vitamin D supplementation during pregnancy may be helpful to prevent EOS in term neonates.

 Download the PDF from VitaminDWiki

Clipped from PDF

  • “ The incidence of neonatal sepsis varies between 1 and 8 neonates per 1000 live births
  • Sepsis accounts for more than 25% of neonatal deaths worldwide

Additional cost-effective uses of Vitamin D in medical emergencies (beyond Sepsis)

Items in both VitaminDWiki categories: Cost savings with Vitamin D and Trauma and surgery


Sepsis in general (not vitamin D)

A Silent Killer Slate April 2016

  • There is no easy way to diagnose sepsis. The good news is you probably don’t have it, but here’s how to ask your doctor if you’re worried
  • Between 16% and 49 % who get Sepsis will die.
  • Until recently, the CDC failed to even mention sepsis in it’s A–Z index of medical terms
  • Sepsis costs the U.S. more than $20 billion per year
  •  Download "Surviving Sepsis 2012" PDF from VitaminDWiki
    referenced by Wikipedia
  • Septic Shock - Medical dictionary has the following chart

Image

The first world Sepsis congress was held Sept 2016
Image
Sepsis is an orphan disease - it affects so many parts of the body that no single medical profession focuses on it
Medicine.Net has a great Sepsis description
Source: http://www.medicinenet.com/script/main/art.asp?articlekey=97492
Medical Authors: Charles Patrick Davis, MD, PhD, Medical Editor:Melissa Conrad Stöppler, MD

Sepsis (blood poisoning) facts
Sepsis is a potentially life-threatening medical condition that's associated with an infection; the infection's signs and symptoms must fulfill a minimum of two criteria of a systemic inflammatory response syndrome (SIRS).
Blood poisoning is a nonmedical term that usually refers to the medical condition known as sepsis.
The major SIRS criteria are an increased heart rate, fever, and increased respiratory rate; the young and the elderly may show other early signs and symptoms of sepsis sometimes before exhibiting SIRS criteria.
The majority of cases of sepsis are due to bacterial infection.
Sepsis is treated with hospitalization, intravenous antibiotics, and therapy to support any organ dysfunction.
Prevention of infections and early diagnosis and treatment of sepsis are the best ways to prevent sepsis or reduce the problems sepsis causes.
The prognosis depends on the severity of sepsis as well as the underlying health status of the patient; in general, the elderly have the worst prognosis.

What is sepsis?
Sepsis is a potentially dangerous or life-threatening medical condition, found in association with a known or suspected infection (usually caused by but not limited to bacteria) whose signs and symptoms fulfill at least two of the following criteria of a systemic inflammatory response syndrome (SIRS):

  • elevated heart rate (tachycardia) >90 beats per minute at rest
  • body temperature either high (>100.4 F or 38 C) or low (<96.8 F or 36 C)
  • increased respiratory rate of >20 breaths per minute or a reduced PaCO2 (partial pressure of carbon dioxide in arterial blood level)
  • abnormal white blood cell count (>12,000 cells/µL or <4,000 cells/µL or >10% bands [an immature type of white blood cell])

Patients who meet the above criteria have sepsis and are also termed septic. These criteria described above were proposed by several medical societies and may continue to be modified by other medical groups. For example, pediatric groups use the same four criteria listed above but modify the values for each to make the SIRS criteria for children. Other groups want to add criteria, but currently this is the most widely accepted definition.

What causes sepsis?
The majority of cases of sepsis are due to bacterial infections, some are due to fungal infections, and very few are due to other causes of infection or agents that may cause SIRS. The infectious agents, usually bacteria, begin infecting almost any organ location or implanted device (for example, skin, lung, gastrointestinal tract, surgical site, intravenous catheter, etc.). The infecting agents or their toxins (or both) then spread directly or indirectly into the bloodstream. This allows them to spread to almost any other organ system. SIRS criteria result as the body tries to counteract the damage done by these blood-borne agents.

Common bacterial causes of sepsis are gram-negative bacilli (for example, E. coli, P. aeruginosa, E. corrodens, and Haemophilus influenzae in neonates). Other bacteria also causing sepsis are S. aureus, Streptococcus species, Enterococcus species and Neisseria; however, there are large numbers of bacterial genera that have been known to cause sepsis. Candida species are some of the most frequent fungi that cause sepsis. In general, a person with sepsis can be contagious, so precautions such as hand washing, sterile gloves, masks, and clothing coverage should be considered depending on the patient's infection source.

What are the risk factors for sepsis?

  • The very young and the elderly are at greatest risk
  • People in an intensive-care unit
  • People with weakened or compromised immune systems
  • People with devices such as IV catheters, breathing tubes, or other devices
  • People with extensive burns
  • People with severe trauma

What is the treatment for sepsis?
In almost every case of sepsis, patients need to be hospitalized, treated with appropriate intravenous antibiotics, and given therapy to support any organ dysfunction. Sepsis can quickly cause organ damage and death; therapy should not be delayed as statistics suggest as high as a 7% mortality increase per hour if antibiotics are delayed in severe sepsis. Most cases of sepsis are treated in an intensive-care unit (ICU) of the hospital.

Physicians agree that the faster the patient with sepsis is diagnosed and treated, the better the prognosis and fewer complications, if any, for the patient.
Sepsis mortality decreased by 15 percent if conventionally treated within 3 hours - May 2017
Time to Treatment and Mortality during Mandated Emergency Care for Sepsis - NEJM
Image
 Download the PDF from VitaminDWiki

Sepsis is an equal opportunity Killer
Image
it contains 45 additional Sepsis charts

Sepsis overlap with Systemic Inflammatory Response Syndrome

Image

Medscape Aug 2016

Sepsis is the 3rd leading cause of UK hospital deaths
Image

See also VitaminDWiki

Personal note by the founder/admin of VitaminDWiki
My 103 year old father-in-law, who got a lot of vitamin D and Omega-3 , was thought to have sepsis.
Doctors gave up on the sepsis diagnosis after his symptoms went away in a day or so.


Meta-analysis concludes: Sepsis 1.8 X more likely if low vitamin D - June 2015

Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis.
BMC Anesthesiol. 2015 Jun 4;15(1):84. doi: 10.1186/s12871-015-0063-3.
Upala S1,2, Sanguankeo A3,4, Permpalung N5.

BACKGROUND: A number of observational studies have found an association between low vitamin D levels and risk of sepsis. We conducted a systematic review and meta-analysis to determine the overall estimate of risk.

METHODS: This was a systematic review and meta-analysis conducted by online searches (CENTRAL, PubMed/MEDLINE, and EMBASE) was registered in PROSPERO (CRD42014014767). Primary outcome was incidence, prevalence, relative risk or odds ratio of having sepsis or bloodstream infection between patients with vitamin D deficiency and controls.

RESULTS: The initial search yielded 647 articles. Twenty-one articles underwent full-length review and data were extracted from 10 observational studies. Pooled odds ratio of sepsis in participants with vitamin D deficiency was 1.78 (95 % confidence interval CI = 1.55 to 2.03, p < 0.01) compared with controls in studies that reported participant numbers and was 1.45 (95 % CI = 1.26 to 1.66, p < 0.01) in studies that reported an adjusted odds ratio of vitamin D deficiency for developing sepsis. Statistical between-study heterogeneity was low (I(2) = 0 % and 5 %, respectively). Standardized mean difference of 25-hydroxyvitamin D levels in patients with sepsis and controls was -0.24 (95 % CI = -0.49 to 0.00, p = 0.05) and lower in the sepsis group compared with non-sepsis or control participants. The statistical between-study heterogeneity (I(2)) was 0 %.

CONCLUSION: Vitamin D deficiency were associated with an increased susceptibility of sepsis.

PMID: 26041306  Download the PDF from VitaminDWiki


Vitamin D - a new hope for septic shock - July 2013

Is vitamin D supplementation a new hope for the therapy of the septic shock?
Endocr Regul. 2013 Jul;47(3):133-6.
Yılmaz H, Sahiner E, Darcin T, Celik HT, Bilgic MA, Akcay A.

Vitamin D is mainly known for its traditional role in the bone mineralization and calcium homeostasis. Recent studies have shown that vitamin D receptors (VDR) are present in almost all the tissues and cells in the human body. In addition, several studies have revealed that vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. In addition, septic patients have decreased vitamin D binding-protein (DBP) levels which further exacerbate the vitamin D deficiency. The role of vitamin D treatment in sepsis syndrome has been evaluated in animal model of sepsis where 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] administration was associated with improved blood coagulation parameters in sepsis associated with a disseminated intravascular coagulation.

Vitamin D treatment in vitro has also been demonstrated to modulate levels of the systemic inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6), as well as inhibit the lipopolysaccharide (LPS)-induced activation and vasodilation of vascular endothelium.

Vitamin D may enhance the induction of the antimicrobial peptides, cathelicidin and b-defensin, which have been described on mucosal and epithelial surfaces acting as the body's first line of defense against viral and bacterial pathogens.

Vitamin D supplementation may divert attention from relatively simple, natural, and low-cost methods of preventing severe sepsis and septic shock.

Further prospective, randomized and controlled clinical trials of adjunctive vitamin D therapy in patients who are vitamin D deficient are needed in the management of human sepsis syndrome.

PMID: 23889483


Sepsis increased 3.5X in a decade - increased reporting or decreased vitamin D?

Image
Should we track sepsis trends using administrative data? March 2016


Sepsis mortality reduced 4X with Intravenous Vitamin C, Thiamine, and hydrocortisone - March 2017 (without any Vitamin D)

Around ten million lives per year could be saved from Sepsis using $60 treatment of intravenous Vitamin C, Vitamin B and hydrocortisone

 Download the PDF from VitaminDWiki
They injected all Sepsis patients for 6 months and compared results from patients in the previous 6 months
Image
Editorial in Chest, online 7 April 2017: How to give vitamin C a cautious but fair chance in severe sepsis
 Download the PDF from VitaminDWiki
Study Described in Naturalhealth April 2017
Vitamin C and sepsis: The genie is now out of the bottle May 2017
   by Dr. Levi (writen a nice book on Vitamin C) - which is also in naturalhealth
Review of study by Mercola - July 2017 has video interview of the study author
". . .has already made the protocol its standard of care for sepsis. The hospital president is considering making it standard of care in its other 12 hospitals as well."

Might Vitamin D be synergistic with this Vitamin C combination?


Sepsis injection of 300,000 IU of vitamin D helped in a small RCT Feb 2017

Reduced length of stay and deaths - not statistically significant - too small of a trial
[Effect of vitamin D3 on the severity and prognosis of patients with sepsis: a prospective randomized double-blind placebo study]
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Feb;29(2):106-110. doi: 10.3760/cma.j.issn.2095-4352.2017.02.003.
[Article in Chinese]
Ding F1, Zang B, Fu J, Ji K.

OBJECTIVE:
To observe the relationship between vitamin D3 and the severity as well as prognosis in patients with sepsis, and to explore whether exogenous vitamin D3 can improve the prognosis in patients with sepsis.

METHODS:
A prospective randomized double-blind placebo study was conducted. Fifty-seven patients with sepsis admitted to intensive care unit (ICU) of Shengjing Hospital Affiliated to China Medical University from March to November in 2015 were enrolled. Twenty patients with systemic inflammatory response syndrome (SIRS) and 20 healthy volunteers with normal physical examination as control were enrolled during the same time. Patients with sepsis were divided into general sepsis group and severe sepsis group (including septic shock) according to the criteria for the diagnosis of severe sepsis and septic shock in 2012. According to the diagnostic criteria established by the American Endocrine Society, and on the basis of 25-hydroxy vitamin D3 [25(OH)D3], the sepsis patients with deficiency [25(OH)D3 20-30 μg/L] or insufficiency [25(OH)D3 < 20 μg/L] of vitamin D were divided into D3 treatment group (supplemented 300 kU vitamin D3) and placebo group (injected 1 mL physiological saline). 28th day was set as the end point, and the patients with sepsis were divided into survival group and death group. The levels of serum 25(OH)D3 in each group were measured by electrochemical luminescence method, and the difference in 25(OH)D3 levels among patients with different severity, gender, and age were recorded. Procalcitonin (PCT), C-reactive protein (CRP), blood routine, liver and kidney function, electrolytes and arterial blood gas analysis, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure score (SOFA), duration of mechanical ventilation, and length of ICU stay of patients with sepsis were observed. Multivariate Cox proportional hazard regression analysis was used to analyze the risk factors of prognosis in patients with sepsis.

RESULTS:
(1) In 57 patients with sepsis, there were 15 patients in general sepsis group, and 42 in severe sepsis group; 29 in D3 treatment group, and 28 in the placebo group; 8 patients died within 28 days with mortality rate of 14.04%. (2) The levels of serum 25(OH)D3 in sepsis group and SIRS group were significantly lower than those in healthy control group [μg/L: 3.92 (< 3.00, 11.22), 6.99 (3.51, 9.77) vs. 17.25 (13.48, 22.50), both P < 0.01], but there was no significant difference in the serum 25(OH)D3 level between sepsis group and SIRS group as well as patients with different degrees of sepsis. The serum 25(OH)D3 level in female patients with sepsis (n = 24) was significantly lower than that in male (n = 33), and the difference was statistically significant [μg/L: <3.00 (<3.00, 3.87) vs. 11.96 (5.14, 17.29), Z = -4.020, P = 0.000]. There was no significant difference in serum 25(OH)D3 level between the young (age <60 years old, n = 30) and the old (age ≥ 60 years old, n = 27) patients with sepsis [μg/L: 4.54 (<3.00, 9.88) vs. 3.00 (<3.00, 15.08), Z = -0.601, P = 0.548]. (3) In patients with sepsis, there was no significant difference in the duration of mechanical ventilation [hours: 41.00 (7.50, 82.50) vs. 67.00 (4.75, 127.75)], length of ICU stay (days: 5.48±4.08 vs. 6.68±4.87) and 28-day mortality (10.34% vs. 17.86%) between D3 treatment group and placebo group (all P > 0.05). It was shown by Kaplan-Meier survival curve analysis that there was no significance in 28-day accumulated survived rate between the two groups [log-rank test: χ 2 = 0.222, P = 0.638]. It was shown by multivariate Cox regression analysis that APACHE II score [relative risk (RR) = 8.487, 95% confidence interval (95%CI) = 1.506-47.835, P = 0.015] and 25(OH)D3 < 20 μg/L (RR = 0.088, 95%CI = 0.013-0.592, P = 0.012) were the risk factors of prognosis in patients with sepsis.

CONCLUSIONS:
The serum 25(OH)D3 level in ICU patients with sepsis was lower than that in healthy people, but there was no significant difference between patients with sepsis and SIRS. The serum 25(OH)D3 level in sepsis patients was related with gender, and the level of the female was lower than that of the male, but was not related with age. Exogenous vitamin D3 supplementation cannot improve the prognosis of ICU patients with sepsis. APACHE II score and 25(OH)D3 < 20 μg/L were risk factors for the prognosis in ICU patients with sepsis.

PMID: 28625255 DOI: 10.3760/cma.j.issn.2095-4352.2017.02.003

Vitamin D reduces sepsis        

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8515 Sepsis 3rd.jpg admin 05 Oct, 2017 00:08 25.05 Kb 177
8514 Sepsis - the equal opportunity killer.jpg admin 04 Oct, 2017 18:00 73.12 Kb 218
8322 SEPSIS SIRS.jpg admin 20 Aug, 2017 15:22 25.22 Kb 257
8120 Sepsis 3 definition.pdf PDF 2017 admin 21 Jun, 2017 20:44 672.30 Kb 61
8074 How to give Vit C for Sepsis.pdf PDF 2017 admin 07 Jun, 2017 12:13 149.44 Kb 159
8073 Vit C Sepsis.pdf PDF 2017 admin 07 Jun, 2017 12:06 497.96 Kb 91
8016 Sepsis mortality decreased by 15 percent.jpg admin 22 May, 2017 18:32 25.56 Kb 554
8015 Fast treatment of sepsis helps.pdf PDF 2017 admin 22 May, 2017 18:29 374.91 Kb 174
8011 Amrein F2.jpg admin 21 May, 2017 15:59 17.42 Kb 505
8010 Amrein 2014.jpg admin 21 May, 2017 15:59 51.86 Kb 533
8009 Amrein 2014.pdf PDF 2014 admin 21 May, 2017 15:58 325.46 Kb 86
8001 Sepsis April 2017.pdf PDF 2017 admin 19 May, 2017 17:53 909.62 Kb 88
7988 Sepsis trend.jpg admin 15 May, 2017 13:47 35.15 Kb 624
7965 Sepsis - first world congress.jpg admin 04 May, 2017 02:16 50.71 Kb 621
7964 Response with Sepsis.jpg admin 04 May, 2017 00:32 19.97 Kb 577
7963 Sepsis RCT.pdf PDF 2015 admin 03 May, 2017 23:41 793.91 Kb 106
7909 Sepsis mortality.jpg admin 10 Apr, 2017 21:34 15.39 Kb 711
7908 Sepsis injection.pdf PDF 2017 admin 10 Apr, 2017 21:32 495.64 Kb 90
7090 Sepsis CDC 2008.jpg admin 21 Sep, 2016 01:29 41.44 Kb 804
7067 Neonatal sepsis.pdf PDF admin 11 Sep, 2016 20:31 310.16 Kb 333
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5592 Surviving Sepsis Campaign 2012.pdf PDF admin 19 Jun, 2015 11:13 3.31 Mb 751
5591 LL-37.jpg admin 19 Jun, 2015 01:29 93.18 Kb 5170
5590 Sepsis meta-analysis June 2015.pdf PDF 2015 admin 19 Jun, 2015 00:26 1,015.97 Kb 801
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