Öz
Amaç: Bu çalışmanın amacı yoğun bakım hastalarında D vitamini ve magnezyum düzeylerinin sepsis ve septik şokun şiddeti ile ilişkisini araştırmaktır.
Yöntemler: Üçüncü basamak bir hastanenin YBÜ'sünde Ocak 2017 ile Ocak 2019 tarihleri arasında kabul edilen 299 sepsis hastasını kapsayan retrospektif bir çalışma yapılmıştır. Hastaların demografik verileri, D vitamini ve magnezyum düzeyleri, laboratuvar parametreleri ve klinik skorları (APACHE II, SOFA, SAPS II) başvuru ve taburculuk sırasında toplanmıştır. Bu mikro besin öğeleri ile mortalite arasındaki ilişkiyi değerlendirmek için ki-kare ve korelasyon analizi dahil olmak üzere istatistiksel analizler yapılmıştır.
Bulgular: Sonuçlar, hipomagnezeminin APACHE II ve SOFA dahil olmak üzere daha yüksek klinik ciddiyet skorlarıyla ilişkili olduğunu gösterirken (p<0,05), ne D vitamini ne de magnezyum seviyelerinin bağımsız olarak mortaliteyi öngörmediğini göstermiştir. Magnezyum eksikliği daha kötü klinik sonuçlarla ilişkilidir (p<0.05) ancak mortalite ile ilişkisi yetersiz kalmıştır (p>0.05). Benzer şekilde, düşük D vitamini düzeyleri yaygın olmasına rağmen sağkalımı önemli ölçüde etkilememiştir (p>0.05).
Sonuç: D vitamini ve magnezyum düzeyleri sepsis hastalarında mortalite ile bağımsız olarak ilişkili bulunmamıştır. Bununla birlikte, magnezyum eksikliği daha yüksek şiddet skorlarıyla bağlantılı olup, hastalığın ilerlemesindeki potansiyel rolüne işaret etmektedir. Kritik hastalarda bu eksikliklerin düzeltilmesinin terapötik etkilerini keşfetmek için daha fazla araştırmaya ihtiyaç vardır.
Kaynakça
- Amrein K, Schnedl C, Holl A, Riedl R, Christopher KB, Pachler C, et al. (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. Journal of the American Medical Association, 312(15), 1520-1530.
- Angus DC, van der Poll T. (2013). Severe sepsis and septic shock. The New England Journal of Medicine, 369(9) 840-851
- Aygencel G, Turkoglu M, Tuncel AF, Candır BA, Bildacı YD, Pasaoglu H. (2013). Is Vitamin D insufficiency associated with mortality of critically ill patients? Critical Care Research and Practice, 856747.
- Geiger C, McNally JD, Christopher KB, Amrein K. (2024). Vitamin D in the critically ill - update. Current Opinion in Clinical Nutrition and Metabolic Care, 27(6),515-522.
- Gonuguntla V, Talwar V, Krishna B, Srinivasan G. (2023). Correlation of Serum Magnesium Levels with Clinical Outcome: A Prospective Observational Study in Critically Ill Patients Admitted to a Tertiary Care ICU in India. Indian Journal of Critical Care Medicine, 27(5),342-347.
- Karampela I, Stratigou T, Antonakos G, Kounatidis D, Vallianou NG, Tsilingiris D, et al. (2024). 25-hydroxyvitamin D and parathyroid hormone in new onset sepsis: A prospective study in critically ill patients. Metabolism Open,100296.
- Laddhad DS, Hingane V, Patil TR, Laddhad DD, Laddhad AD, Laddhad SD. (2023). An assessment of serum magnesium levels in critically ill patients: A prospective observational study. International Journal of Critical Illness and Injury Science, 13(3),111-117.
- Lan SH, Lai CC, Chang SP, Lu LC, Hung SH, Lin WT. (2020). Vitamin D supplementation and the outcomes of critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials. Scientific Reports, 10(1),14261.
- Limaye CS, Londhey VA, Nadkart MY, Borges NE. (2011). Hypomagnesemia in critically ill medical patients. Journal of Association of Physicians of India, 59:19-22.
- Rhee C, Jones TM, Hamad Y, Pande A, Varon J, O'Brien C, et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US Acute Care Hospitals. JAMA Network Open, 2(2), e187571.
- Rosanoff A, Weaver CM, Rude RK. (2012). Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutrition Reviews, 70(3),153-164.
- Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW. (1993). Association of hypomagnesemia and mortality in acutely ill medical patients. Critical Care Medicine, 21(2), 203-209.
- Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. (2020). Global, regional, and national sepsis incidence and mortality, 1990-2017: Analysis for the Global Burden of Disease Study. Lancet, 395(10219), 200-211.
- Solanki J, Runwal K, Beke N, Bahulikar A, Phalgune D. (2022). Serum magnesium levels in critically Ill patients on admission in ICU and its correlation with outcome. Journal of Association of Physicians of India,70(5),11-12. Tonai K, Katayama S, Koyama K, Imahase H, Nunomiya S. (2024). Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study. Journal of Anesthesia, Analgesia and Critical Care, 3, 4(1), 23.
- Velissaris D, Karamouzos V, Pierrakos C, Aretha D. Karanikolas M (2015). Hypomagnesemia in Critically Ill Sepsis Patients. Journal of Clinical Medicine Research, 7(12), 911-918.
- Viglianti EM, Zajic P, Iwashyna TJ, Amrein K. (2019). Neither vitamin D levels nor supplementation are associated with the development of persistent critical illness: a retrospective cohort analysis. Journal of Clinical Medicine Research, 21(1), 39-44.
- Wang AY, Yeh YC, Cheng KH, Han YY, Chiu CT, Chang CC, et al. (2024). Efficacy and safety of enteral supplementation with high-dose vitamin D in critically ill patients with vitamin D deficiency. Journal of the Formosan Medical Association, S0929-6646(24),241-249.
- Yealy DM, Mohr NM, Shapiro NI, Venkatesh A, Jones AE, Self WH. (2021). Early care of adults with suspected sepsis in the emergency department and out-of-hospital environment: A consensus-based task force report. Annals of Emergency Medicine, 78(1), 1-19
Öz
Objective: This study aims to investigate the association of vitamin D and magnesium levels with the severity of sepsis and septic shock in ICU patients.
Methods: A retrospective study was conducted in the ICU of a tertiary hospital, involving 299 sepsis patients admitted between January 2017 and January 2019. Patients' demographic data, vitamin D and magnesium levels, labarotory parameters, and clinical scores (APACHE II, SOFA, SAPS II) were collected at admission and discharge. Statistical analyses, including chi-square and correlation analysis, were performed to evaluate the association between these micronutrients and mortality.
Results: The results showed that while hypomagnesemia was associated with higher clinical severity scores, including APACHE II and SOFA (p<0.05), neither vitamin D nor magnesium levels were independently predictive of mortality. Magnesium deficiency correlated with worse clinical outcomes,(p<0.05) but its association with mortality remained inconclusive (p>0.05). Similarly, low vitamin D levels, though prevalent, did not significantly influence survival (p>0.05).
Conclusion: Vitamin D and magnesium levels were not independently associated with mortality in sepsis patients. However, magnesium deficiency was linked to higher severity scores, indicating its potential role in disease progression. Further research is needed to explore the therapeutic implications of correcting these deficiencies in critically ill patients.
Etik Beyan
Atatürk University Faculty of Medicine ethics committee approval was received. Ethics Committee Approval No: 39, Session No: 01, Date: 13 February 2019
Destekleyen Kurum
No financial support was received for this study. This study was supported by author
Kaynakça
- Amrein K, Schnedl C, Holl A, Riedl R, Christopher KB, Pachler C, et al. (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. Journal of the American Medical Association, 312(15), 1520-1530.
- Angus DC, van der Poll T. (2013). Severe sepsis and septic shock. The New England Journal of Medicine, 369(9) 840-851
- Aygencel G, Turkoglu M, Tuncel AF, Candır BA, Bildacı YD, Pasaoglu H. (2013). Is Vitamin D insufficiency associated with mortality of critically ill patients? Critical Care Research and Practice, 856747.
- Geiger C, McNally JD, Christopher KB, Amrein K. (2024). Vitamin D in the critically ill - update. Current Opinion in Clinical Nutrition and Metabolic Care, 27(6),515-522.
- Gonuguntla V, Talwar V, Krishna B, Srinivasan G. (2023). Correlation of Serum Magnesium Levels with Clinical Outcome: A Prospective Observational Study in Critically Ill Patients Admitted to a Tertiary Care ICU in India. Indian Journal of Critical Care Medicine, 27(5),342-347.
- Karampela I, Stratigou T, Antonakos G, Kounatidis D, Vallianou NG, Tsilingiris D, et al. (2024). 25-hydroxyvitamin D and parathyroid hormone in new onset sepsis: A prospective study in critically ill patients. Metabolism Open,100296.
- Laddhad DS, Hingane V, Patil TR, Laddhad DD, Laddhad AD, Laddhad SD. (2023). An assessment of serum magnesium levels in critically ill patients: A prospective observational study. International Journal of Critical Illness and Injury Science, 13(3),111-117.
- Lan SH, Lai CC, Chang SP, Lu LC, Hung SH, Lin WT. (2020). Vitamin D supplementation and the outcomes of critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials. Scientific Reports, 10(1),14261.
- Limaye CS, Londhey VA, Nadkart MY, Borges NE. (2011). Hypomagnesemia in critically ill medical patients. Journal of Association of Physicians of India, 59:19-22.
- Rhee C, Jones TM, Hamad Y, Pande A, Varon J, O'Brien C, et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US Acute Care Hospitals. JAMA Network Open, 2(2), e187571.
- Rosanoff A, Weaver CM, Rude RK. (2012). Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutrition Reviews, 70(3),153-164.
- Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW. (1993). Association of hypomagnesemia and mortality in acutely ill medical patients. Critical Care Medicine, 21(2), 203-209.
- Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. (2020). Global, regional, and national sepsis incidence and mortality, 1990-2017: Analysis for the Global Burden of Disease Study. Lancet, 395(10219), 200-211.
- Solanki J, Runwal K, Beke N, Bahulikar A, Phalgune D. (2022). Serum magnesium levels in critically Ill patients on admission in ICU and its correlation with outcome. Journal of Association of Physicians of India,70(5),11-12. Tonai K, Katayama S, Koyama K, Imahase H, Nunomiya S. (2024). Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study. Journal of Anesthesia, Analgesia and Critical Care, 3, 4(1), 23.
- Velissaris D, Karamouzos V, Pierrakos C, Aretha D. Karanikolas M (2015). Hypomagnesemia in Critically Ill Sepsis Patients. Journal of Clinical Medicine Research, 7(12), 911-918.
- Viglianti EM, Zajic P, Iwashyna TJ, Amrein K. (2019). Neither vitamin D levels nor supplementation are associated with the development of persistent critical illness: a retrospective cohort analysis. Journal of Clinical Medicine Research, 21(1), 39-44.
- Wang AY, Yeh YC, Cheng KH, Han YY, Chiu CT, Chang CC, et al. (2024). Efficacy and safety of enteral supplementation with high-dose vitamin D in critically ill patients with vitamin D deficiency. Journal of the Formosan Medical Association, S0929-6646(24),241-249.
- Yealy DM, Mohr NM, Shapiro NI, Venkatesh A, Jones AE, Self WH. (2021). Early care of adults with suspected sepsis in the emergency department and out-of-hospital environment: A consensus-based task force report. Annals of Emergency Medicine, 78(1), 1-19
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Yoğun Bakım |
| Bölüm | Orijinal Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 29 Nisan 2025 |
| Yayımlanma Tarihi | 30 Nisan 2025 |
| Gönderilme Tarihi | 15 Ocak 2025 |
| Kabul Tarihi | 18 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 |
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