Clinical Investigation| Volume 365, ISSUE 4, P361-367, April 2023

Vitamin D deficiency on admission to the emergency department is a mortality predictor for patients with septic shock treated with early protocol-driven resuscitation bundle therapy

Published:October 17, 2022DOI:



      Vitamin D is an important immune modulator and is associated with susceptibility to infection. However, past studies have reported inconsistent results regarding the association between vitamin D deficiency and mortality in patients with sepsis, and early-stage data regarding septic shock are limited. This study aimed to determine the relationship between vitamin D deficiency on admission to the emergency department (ED) and mortality in patients with septic shock.


      We analyzed prospectively collected data on adult patients with septic shock who were treated with protocol-driven resuscitation bundle therapy in the ED between September 2019 and February 2021. Septic shock was defined by the sepsis-3 definition and vitamin D deficiency was defined as a 25-hydroxyvitamin D <20 ng/ml. The primary outcome was 30-day mortality.


      A total of 302 patients were included, 236 (78.1%) patients had vitamin D deficiency; it was significantly higher in non-survivors than in survivors (89.3% vs. 73.9%, P = 0.004). Mortality was higher in vitamin D deficient patients than in non-deficient patients (31.8% vs. 13.6%, P = 0.004). In multivariate analysis, vitamin D deficiency (odds ratio [OR], 2.43; 95 % confidence interval [CI], 1.03–5.74), hyperlactatemia (OR, 3.65; 95 % CI, 1.95–6.83), Sequential Organ Failure Assessment scores (OR, 1.22; 95% CI, 1.09–1.36), and albumin levels (OR, 0.39; 95% CI, 0.21–0.73) were significantly associated with 30-day mortality.


      Vitamin D deficiency was prevalent in patients with septic shock visiting the ED and was associated with mortality.

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