{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T06:35:32Z","timestamp":1763706932367,"version":"3.41.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Vitamin D, an essential fat-soluble micronutrient, exerts diverse physiological effects including the regulation of calcium ion homeostasis, modulation of immune response, and enhancement of resistance against infectious pathogens. Empirical investigations have elucidated an association between inadequate levels of vitamin D and adverse clinical outcomes in critically ill cohorts, with a noteworthy prevalence of vitamin D deficiency observed among patients afflicted with acute kidney injury (AKI). In the context of this retrospective inquiry, our aim was to assess the potential correlation between vitamin D supplementation administered during admission to the intensive care unit (ICU) and the improvement of outcomes specifically in cases of severe AKI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV), a repository of ICU patient records from Beth Israel Deaconess Medical Center (BIDMC) in the United States. We focused on patients diagnosed with epsis-associated acute kidney injury (SA-AKI), dividing them into those who received vitamin D supplementation during their ICU admission and those who did not. Our primary analysis evaluated in-hospital mortality using various statistical methods, such as Kaplan\u2013Meier survival curves, Cox proportional hazards regression models, and subgroup analyses. To enhance the robustness of our findings, we used propensity score matching (PSM) to reduce potential biases. Secondary outcomes included 28-day, 90-day mortality rates and norepinephrine-free days at 28\u202fdays.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this investigation, a cohort of 11,896 individuals diagnosed with SA-AKI was studied. Among them, 2,724 patients received vitamin D supplementation (the vitamin D group) while 9,172 did not (the no-vitamin D group). Kaplan\u2013Meier survival analysis indicated a significant difference in survival probabilities between the two cohorts. Upon adjusting for potential confounders using Cox regression modeling, a notably decreased risk of hospitalization and ICU mortality was observed in the vitamin D group compared to the no-vitamin D group, with an adjusted risk ratio for in-hospital mortality of 0.56 (95% CI: 0.5\u20130.63). These findings were consistent following PSM and subsequent adjustments for propensity score, pairwise algorithm (PA), and overlapping weights (OW) analyses, yielding hazard ratios ranging from 0.53 to 0.59, all with <jats:italic>p<\/jats:italic>-values &amp;lt;0.001. Notably, E-value analyses underscored the robustness of these results against potential unmeasured confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that vitamin D supplementation may be associated with a reduced in-hospital mortality rate among SA-AKI patients in the ICU. Furthermore, the 28-day, 90-day mortality rates and norepinephrine days were significantly reduced in the group receiving vitamin D supplementation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1453522","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T04:23:43Z","timestamp":1733113423000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Vitamin D supplementation may be beneficial in improving the prognosis of patients with sepsis-associated acute kidney injury in the intensive care unit: a retrospective study"],"prefix":"10.3389","volume":"11","author":[{"given":"Jie","family":"Sun","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jue","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongwei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhefeng","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongsheng","family":"Niu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0140-6736(18)30696-2","article-title":"Sepsis and septic shock","volume":"392","author":"Cecconi","year":"2018","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute kidney injury","volume":"7","author":"Kellum","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.ccc.2020.11.010","article-title":"Sepsis-associated acute kidney injury","volume":"37","author":"Manrique-Caballero","year":"2021","journal-title":"Crit Care Clin"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1038\/s41581-023-00683-3","article-title":"Sepsis-associated acute kidney injury: consensus report of the 28th acute disease quality initiative workgroup","volume":"19","author":"Zarbock","year":"2023","journal-title":"Nat Rev Nephrol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"145","DOI":"10.3390\/ijms20010145","article-title":"Vitamin D and human health","volume":"20","author":"Zmijewski","year":"2019","journal-title":"IJMS"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N Engl J Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1177\/0310057X1704500106","article-title":"Altered blood levels of Vitamin D, cathelicidin and parathyroid hormone in patients with Sepsis\u2014a pilot study","volume":"45","author":"Greulich","year":"2017","journal-title":"Anaesth Intensive Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"199","DOI":"10.4103\/ijccm.IJCCM_192_16","article-title":"Correlation of serum Vitamin D level with mortality in patients with Sepsis","volume":"21","author":"Vipul","year":"2017","journal-title":"Indian J Crit Care Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"20365","DOI":"10.1038\/s41598-022-24560-4","article-title":"Serum vitamin D levels and acute kidney injury: a systemic review and meta-analysis","volume":"12","author":"Zhang","year":"2022","journal-title":"Sci Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e12331","DOI":"10.14814\/phy2.12331","article-title":"Vitamin D deficiency aggravates ischemic acute kidney injury in rats","volume":"3","author":"de Bragan\u00e7a","year":"2015","journal-title":"Physiol Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/SHK.0000000000000052","article-title":"A unified theory of Sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury","volume":"41","author":"Gomez","year":"2014","journal-title":"Shock"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1515\/ijb-2012-0030","article-title":"A weighting analogue to pair matching in propensity score analysis","volume":"9","author":"Li","year":"2013","journal-title":"Int J Biostat"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1080\/01621459.2016.1260466","article-title":"Balancing covariates via propensity score weighting","volume":"113","author":"Li","year":"2018","journal-title":"J Am Stat Assoc"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1056\/NEJMoa1809944","article-title":"Vitamin D supplements and prevention of Cancer and cardiovascular disease","volume":"380","author":"Manson","year":"2019","journal-title":"N Engl J Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1001\/jama.2018.21554","article-title":"Using the E-value to assess the potential effect of unmeasured confounding in observational studies","volume":"321","author":"Haneuse","year":"2019","journal-title":"JAMA"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s40279-013-0036-y","article-title":"Vitamin D and physical performance","volume":"43","author":"Moran","year":"2013","journal-title":"Sports Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/S2213-8587(21)00051-6","article-title":"Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials","volume":"9","author":"Jolliffe","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1126\/science.adh7954","article-title":"Vitamin D regulates microbiome-dependent cancer immunity","volume":"384","author":"Giampazolias","year":"2024","journal-title":"Science"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"288","DOI":"10.2174\/1570159X17666191108111120","article-title":"Vitamin D and depression in women: a Mini-review","volume":"18","author":"Boulkrane","year":"2020","journal-title":"Curr Neuropharmacol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"651","DOI":"10.3390\/nu9070651","article-title":"Vitamin D and infectious diseases: simple bystander or contributing factor?","volume":"9","author":"Gois","year":"2017","journal-title":"Nutrients"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2663","DOI":"10.3390\/ijms19092663","article-title":"Vitamin D: effect on Haematopoiesis and immune system and clinical applications","volume":"19","author":"Medrano","year":"2018","journal-title":"IJMS"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e53678","DOI":"10.7759\/cureus.53678","article-title":"A comprehensive review of the immunomodulatory effects of Vitamin D in Sepsis","volume":"16","author":"Ahuja","year":"2024","journal-title":"Cureus"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e72","DOI":"10.4037\/ajcc2014723","article-title":"Deficiency in 25-Hydroxyvitamin D and 30-day mortality in patients with severe Sepsis and septic shock","volume":"23","author":"Rech","year":"2014","journal-title":"Am J Crit Care"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/j.kint.2019.05.026","article-title":"Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment","volume":"96","author":"Peerapornratana","year":"2019","journal-title":"Kidney Int"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.3390\/ijms23031702","article-title":"Disruption of kidney\u2013immune system crosstalk in Sepsis with acute kidney injury: lessons learned from animal models and their application to human health","volume":"23","author":"LaFavers","year":"2022","journal-title":"IJMS"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e016486","DOI":"10.1136\/bmjopen-2017-016486","article-title":"Vitamin D levels in critically ill patients with acute kidney injury: a protocol for a prospective cohort study (VID-AKI)","volume":"7","author":"Cameron","year":"2017","journal-title":"BMJ Open"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"105789","DOI":"10.1016\/j.jsbmb.2020.105789","article-title":"Vitamin D\/VDR attenuate cisplatin-induced AKI by down-regulating NLRP3\/Caspase-1\/GSDMD pyroptosis pathway","volume":"206","author":"Jiang","year":"2021","journal-title":"J Steroid Biochem Mol Biol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1111\/cen.12172","article-title":"Dysregulated mineral metabolism in patients with acute kidney injury and risk of adverse outcomes","volume":"79","author":"Leaf","year":"2013","journal-title":"Clin Endocrinol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e64964","DOI":"10.1371\/journal.pone.0064964","article-title":"Is the serum Vitamin D level at the time of hospital-acquired acute kidney injury diagnosis associated with prognosis?","volume":"8","author":"Lai","year":"2013","journal-title":"PLoS One"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s13054-024-04869-4","article-title":"Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study","volume":"28","author":"Cameron","year":"2024","journal-title":"Crit Care"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1334524","DOI":"10.3389\/fmed.2024.1334524","article-title":"Vitamin D supplementation may be beneficial in improving the prognosis of patients with chronic obstructive pulmonary disease in the intensive care unit: a retrospective study","volume":"11","author":"He","year":"2024","journal-title":"Front Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"2924","DOI":"10.3390\/nu15132924","article-title":"Vitamin D supplementation during intensive care unit stay is associated with improved outcomes in critically ill patients with Sepsis: a cohort study","volume":"15","author":"Yang","year":"2023","journal-title":"Nutrients"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"10725","DOI":"10.3390\/ijms231810725","article-title":"The perspective of Vitamin D on suPAR-related AKI in COVID-19","volume":"23","author":"Liao","year":"2022","journal-title":"IJMS"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"625647","DOI":"10.3389\/fmed.2021.625647","article-title":"The restoration of Vitamin D levels slows the progression of renal ischemic injury in rats previously deficient in Vitamin D","volume":"8","author":"Dos Santos","year":"2021","journal-title":"Front Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1453522\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T04:23:45Z","timestamp":1733113425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1453522\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,2]]},"references-count":35,"alternative-id":["10.3389\/fmed.2024.1453522"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1453522","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2024,12,2]]},"article-number":"1453522"}}