COVID-19 Increases Sepsis Risk: Potential Therapeutic Benefits of Vitamin D

Recent research has found that sepsis is more common and lethal among COVID-19 patients than previously thought.

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Recent research has found that sepsis is more common and lethal among COVID-19 patients than previously thought.

Sepsis is a highly severe clinical syndrome, often originating from lung infections, urinary tract, skin, or gastrointestinal tract, involving pathogens such as fungi, bacteria, viruses (including COVID-19 and influenza), and more. The immune system becomes hyperactive when combating these infections, leading to systemic inflammation and tissue necrosis. In severe cases, it can result in shock, organ failure, and even death.

A study revealed that for every one-hour delay in the administration of targeted antibiotics, antifungal, or antiviral medications after the onset of organ dysfunction or shock, the odds of a poor outcome increase by 3 percent to 7 percent. Sepsis treatment in the United States is estimated to cost $23.7 billion annually, making it the most expensive condition for inpatient care.

One retrospective cohort study published in JAMA Network Open in September conducted on 431,017 patients (with an average age of 57.9) hospitalized in five hospitals in Massachusetts between March 2020 and November 2022 found that COVID-19-associated sepsis was present in 1.5 percent of all admissions and 28.2 percent of COVID-19-positive hospitalizations. Additionally, presumed bacterial sepsis was present in 7.1 percent of hospitalizations.

The researchers also found that in the first 33 months of the COVID-19 pandemic, approximately one-sixth of sepsis cases were attributed to COVID-19.

Between the first and last quarters of the study, the mortality rate of COVID-19-related sepsis decreased from 33.4 to 14.9 percent, while presumed bacterial sepsis mortality was stable at 14.5 percent.

The research findings also indicated that sepsis caused by COVID-19 was quite common and had a higher mortality rate than presumed bacterial sepsis.

Another study suggested that sepsis caused by COVID-19 is due to immune dysregulation triggered by the COVID-19 infection. Relative immune suppression can make otherwise healthy patients susceptible to the development of sepsis rather than being a result of direct viral damage.

An Italian narrative review published in 2021 highlighted that, based on the latest epidemiological trends, the incidence of sepsis is on the rise, especially among the elderly population, where the incidence is over five times higher compared to other age groups. In-hospital mortality from sepsis is estimated to be 140 percent higher than annual estimates of mortality caused by other reasons. Approximately one in every two to three deaths is attributed to sepsis among hospitalized patients.

Vitamin D: An Essential Adjunctive Treatment

Vitamins are essential micronutrients in the human body, playing a crucial role in numerous biological pathways associated with sepsis, including antioxidant and anti-inflammatory functions, protein and hormone synthesis, energy production, and gene regulation.

Dr. Ryoichi Nakahara, who holds a doctorate in surgery from the University of Tokyo, stated during an interview with The Epoch Times that the high metabolic state triggered by the immune response in sepsis patients rapidly depletes micronutrients in the body. Numerous vitamin trials have suggested that vitamin D, vitamin C, and other micronutrient supplements offer a fresh perspective on sepsis treatment.

An observational study was published in The American Journal of the Medical Sciences in April. The study included 302 sepsis patients with an average age of 65.5, observed over 30 days. The results indicated that patients with vitamin D deficiency had a higher mortality rate (31.8 percent) than those without (13.6 percent). After adjusting for significant variables like hemoglobin levels, malignancy, albumin levels, and hyperlactatemia, vitamin D deficiency was identified as an independent predictor of 30-day mortality.

The researchers believe that vitamin D plays multiple roles in the immune system’s response to infections, making it a potential key component in combating sepsis.

In the Italian narrative review, another case-control study involving 36 ventilated patients in the ICU demonstrated that the group receiving high-dose intramuscular vitamin D injections showed a significant reduction in the number of ventilation days and length of hospital stay.

A meta-analysis report published in BMC Infectious Diseases in 2020 indicated that vitamin D supplementation can reduce mortality in sepsis patients with severe vitamin D deficiency.

The Importance of Vitamin C Supplementation

Vitamin C possesses significant anti-inflammatory, immune-regulating, antioxidant, anti-thrombotic, and antiviral properties. A narrative review published in Pediatric Research in 2021 revealed that, in animal models, vitamin C has been shown to alleviate sepsis-induced lung injury, enhance lymphocytic proliferation, and reduce pro-inflammatory cytokines such as tumor necrosis factor and interleukin.

An increasing number of evidence suggests the benefits of vitamin C in sepsis treatment. In a prospective, randomized trial of antioxidant therapy, patients at risk of sepsis following major surgery or trauma experienced a significant reduction in the incidence of organ failure and a shorter ICU stay after they were treated with a combination of vitamin C and vitamin E.

Both animal and human studies indicated that high-dose intravenous vitamin C is generally safe and has low or no toxicity.