الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 85 |  |  |
| | | from | 85 | | |
Abstract
Sepsis is a systemic, deleterious host response to infection leading to severe sepsis (acute organ dysfunction secondary to documented or suspected infection) and septic shock (severe sepsis plus hypotension not reversed with fluid resuscitation). Severe sepsis and septic shock are major healthcare problems, affecting millions of people around the world each year, killing one in four (and often more), and increasing in incidence.(1, 2)
Despite the substantial improvement of clinical outcomes since the introduction of early goal-directed therapy,(3) successful treatment remains a great challenge depending mainly on rapid elimination of the responsible microorganism in addition to supportive treatment.(4)
Vitamin D primarily promotes the regulation of the calcium and phosphorus metabolism and is an important regulator of osteomineral parameters. However, the almost universal distribution of vitamin D receptors in human cells suggests that it is involved in systemic homeostasis. Therefore, vitamin D deficiency has been the subject of marked interest by the scientific community and the search for information on its role in critically ill patients is expanding.
Vitamin D regulates both the innate and adaptive immune responses.(77, 78) In addition to its immunomodulatory role, vitamin D appears to suppress inflammatory cytokines, particularly interleukin-6 (IL-6), which trigger systemic inflammatory response syndrome.(81)
Therefor the present prospective observational study was aimed to test whether vitamin D deficiency is related to multi-organ dysfunction and outcomes in a population of septic shock patients.
The study was conducted on 46 adult patients with a recent diagnosis of septic shock, admitted to the emergency room or proceeding from clinical wards; including ICU wards, admitted consequently to Critical Care Medicine Department of Alexandria Main University Hospital. 46 age and sex matched critically ill patients not suffering from severe sepsis were included as a control group. APACHE II and SOFA Scores were calculated for all patients on admission and at day 3. Morbidity was considered if deterioration of SOFA score at day 3 occurred. Mortality was described at day 28 for the pre-defined group. 25 (OH) D was measured from blood samples within 48 hours of ICU admission.
Among 46 cases and 46 well matched control, 24 (52.2%) of cases were suffering of vitamin D deficiency, and 22 (47.8%) of cases were suffering of severe deficiency, while 15 (32.6%) of control had vitamin D deficiency, 12 (26.1%) of control had severe deficiency, 17 (37.0%) of control had insufficient level and only 2 (4.3%) of control had sufficient level.
Our results indicated that vitamin D deficiency in septic shock was significantly associated with increased multi-organ dysfunction (p < 0.01), all-cause 28-day mortality (p < 0.01) and length of ICU stay (p < 0.01) and hospital stay (p < 0.01) in survivors.