Comparison of severity of sepsis with various biochemical parameters

      Background: Vitamin D is an immuno-modulator in humans and its deficiency has been reported in patients in sepsis and may contribute to multi-organ dysfunction and nosocomial infections seen in them. Vitamin D is derived from cholesterol stored in the body by the action of sunlight. Procalcitonin has been a widely accepted parameter for severity of sepsis. OBJECTIVE: To measure vitamin D levels in sepsis patients and to compare it with various mortality indicators used in critically ill patients in sepsis like SAPS II score, Charlson Comorbidity Index, procalcitonin and to find any association between the lipid profile of the patient with vitamin D levels and severity of sepsis calculated by mortality, ICU and hospital length of stay and duration of mechanical ventilation and to match them with vitamin D levels of age and sex matched healthy patients.
      Methods & Materials: IEC permission was obtained to carry out this study. From 96 sepsis patients, plasma vitamin D (measured within first 24 hours after ICU admission as standard of care), demographic data (age, sex), Simplified Acute Physiology Score (SAPS II), mortality were recorded. Co-morbidities were assessed using the age-unadjusted Charlson Comorbidity Index. Procalcitonin levels were noted for patients along with lipid profile, whenever available. Vitamin D values were recorded from age and sex matched non-sepsis OPD patients, taken as controls.
      Results: The average SAPS II score in sepsis patients was 43.49. Correlation of vitamin D with age, procalcitonin levels (fig. 1), ICU length of stay (LOS) (fig. 2), Hospital LOS and mortality showed a negative correlation. Procalcitonin levels had a positive correlation with SAPS II score, days of Mechanical Ventilation (MV), ICU LOS and mortality. The average vitamin D level in patients of sepsis in our study was 15.38 ng/dl and that of controls was 41.11 ng/dl (fig. 3) and Vit D had no significant correlation with lipid profile.
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      Figure 1Showing scatter plot between Vitamin D and PCT (negative correlation)
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      Figure 2Showing scatter plot between Vitamin D and ICU stay (negative correlation)
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      Figure 3Bar chart showing mean Vitamin D levels among controls and cases
      Conclusion: Deficient levels of vitamin D has a possible role in sepsis. Hence supplementation of vitamin D might have a beneficial role in sepsis management and overall outcome. Further interventional studies with larger sample size and supplementation of vitamin D is required to substantiate the findings.