Sepsis, the third leading cause of death, is not registered in Denmark

– and lack of vitamin D increases the risk

The minority of people think about the danger of sepsis, which is a serious blood poisoning. However, according to WHO, sepsis is rather common and it is the third leading cause of death, only surpassed by cardiovascular diseases and cancer. According to Ugeskrift for Læger (the journal of the Danish Medical Association), it is a paradox that Denmark has no official registry of the rate and high mortality of sepsis. Also, the risk of getting sepsis and dying of the condition is heavily increased if you lack vitamin D, according to an Iranian study that is published in Archives of Academic Emergency Medicine. We need to focus more on sepsis, including diagnosis, swift treatment, and prevention of this life-threatening disease.

Sepsis usually starts as an infection in an organ, for instance pneumonia, urinary tract infection (UTI), or a wound infection. Within hours, sepsis can affect the cardiovascular system, the lungs, and a variety of internal organs. The mortality rate can go up as high as 50 percent if the patients go into a septic shock. This is a life-threatening condition caused by the immune defense reacting too violently to the blood infection by launching a cytokine storm with hyperinflammation. This overkill reaction causes the immune system to attack perfectly healthy tissue. The symptoms are often overlooked or misdiagnosed and include high fever, heart palpitations, breathing difficulty, confusion, lethargy, and blurry speech. Many of the symptoms are a result of dehydration. Sepsis calls for immediate attention and is typically treated with corticosteroids to thwart the overactive immune defense. Still, this treatment is often insufficient, and according to WHO, sepsis it the third leading cause of death, only surpassed by cardiovascular disease and cancer. Therefore, it is far better to prevent the complications of this disease, and vitamin D plays an essential role.

According to the 2016 definition, sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
When patients in Denmark have infectious diseases and die of accompanying sepsis, it is typically infection and not sepsis that is listed as the cause of death.
An estimated 56,000 Danes are affected by sepsis on an annual basis and mortality caused by sepsis is estimated to account for 15 percent of deaths.
On a global scale, there are over 31 million cases of sepsis annually and an estimated 5.1 million people die of this disease every year.

Vitamin D activates the immune defense and counteracts life-threatening inflammation

Nearly all cells in the body have vitamin D receptors (VDR) that activate and control a number of genes and a variety of biochemical processes in the body. Vitamin D has a vital role in activating the white immune cells that are designed to attack virus and bacteria swiftly and effectively. If you lack vitamin D, your immune system remains dormant or passive and there is a risk that the infection takes over. Vitamin D also inhibits the production of proinflammatory cytokines that are essential for keeping the immune system on a leash to prevent it from overreacting and causing tissue damage.

The sun during the summer is our primary source of vitamin D
Many people become vitamin D-deficient during the winter period
Spending too much time indoors, being dark-skinned, being overweight, and ageing are all factors that increase the risk of a chronic vitamin D deficiency
An estimated one billion people in the world lack vitamin D

Being vitamin D-deficient increases the risk of dying of sepsis

The scientists behind the Iranian study wanted to look closer at the link between blood levels of vitamin D and the risk of dying of sepsis. They studied 168 patients diagnosed with sepsis, who were older than 18 years and had an average age of 70.8 years. There was an equal number of men and women. Vitamin D levels were measured in all the patients, and blood levels between 20-50 nmol/L were considered normal. It turned out that 61.6 percent of the patients lacked vitamin D. The deficiency significantly increased their risk of dying of sepsis, and this was also the case with old age.
Based on their findings, the scientists assume that vitamin D supplementation may be useful for preventing blood infections and lowering the risk that these infections turn into life-threatening sepsis. This is especially relevant for older patients.

In countries like Denmark, blood levels of vitamin D are categorized as regular deficiency (below 30 nmol/L), insufficiency (30-50 nmol/L), and sufficiency (over 50 nmol/L).
In countries like Iran, the lower vitamin D threshold is only 20 nmol/L
According to international studies the optimal blood levels for vitamin D should ideally be 75 nmol/L and higher

Reference intake (RI) levels and the actual need for vitamin D

In Denmark, the reference intake (RI) level for white adults up to the age of 70 years is 5 micrograms. The Danish health authorities recommend 10 micrograms of supplementary vitamin D daily to pregnant women, toddlers, dark-skinned individuals, and people that do not expose themselves to direct sunlight, while nursing home residents and people from 70 years and older are advised to take 20 micrograms per day. Many scientists claim that the actual need for vitamin D is a lot higher, at least if the goal is to optimize blood levels of the nutrient. High-dosed vitamin D supplements with 20-80 micrograms are available on the market. The body’s actual vitamin D requirement depends on factors like age, skin type, BMI, chronic diseases, and use of cholesterol-lowering drugs (statins). Because vitamin D is a lipid-soluble vitamin, it is best to take it in an oil-based formula in soft gelatin capsules.

What do life-threatening sepsis, COVID-19, and influenza have in common?

When sepsis, COVID-19, and influenza suddenly become life-threatening it is because the immune system overreacts by employing a cytokine storm and hyperinflammation that can attack healthy tissues. It is not the virus or bacteria that causes the problem, it is our own immune system that becomes unleashed because it is in short supply of essential nutrients like vitamin D that are necessary to keep it under control.

References:

Majid Shojaei et al. The Correlation between Serum Level of Vitamin D Outcome of Sepsis Patients; a Cross-sectional Study. Archives of Academic Emergency Medicine 2019

Palle Toft og Thomas Strøm. Sepsis, den tredjehyppigste dødsårsag, registreres ikke i Danmark. Ugeskrift for Læger 2018

Essen MR et al. Vitamin D controls T cell antigen receptor signaling and activation of human T cells. Nat Immunol 2010

University of Copenhagen. Vitamin D crucial to activating immune Defences. 2010

Eamon Laird, Rose Anne Kenny. Vitamin D deficiency in Ireland – implications for COVID 19. Results from the Irish Longitudinal Study on Ageing (TILDA) April 2020

https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/endokrinologi/tilstande-og-sygdomme/knoglevaev-og-vitamin-d/d-vitamin-mangel/

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Created on 11 June 2020.