Albert Einstein College of Medicine, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA.
Crit Care. 2011;15(6):R292. doi: 10.1186/cc10585. Epub 2011 Dec 10.
The incidence of vitamin D deficiency in critically ill patients has been reported to range from as low as 17% to as high as 79%. Data regarding the relationship between 25-hydroxyvitamin D levels and outcomes in the medical intensive care unit are sparse. The goal of the study was to evaluate the prevalence of 25-hydroxyvitamin D deficiency in the medical intensive care unit and its relationship with outcomes.
This was a retrospective study in a medical intensive care unit (MICU) at an inner city community hospital. The study period was between October 2009 and February 2010.
Of the 932 patients admitted during the study period, 25-hydroxyvitamin D vitamin D (25(OH)D) levels were available in 523 (53%); 86 of them were excluded from the study due to readmission to the intensive care unit. Deficiency was defined as 0 to 19.9 ng/dL 25(OH)D levels, insufficiency as 20 to 29.9 ng/dL, and normal levels as ≥30 ng/dL. Of the 437 patients studied, 25(OH)D deficiency was identified in 340 (77.8%), insufficiency in 74 (16.9%), and normal levels in 23 (5.3%) patients. Patients with 25(OH)D deficiency/insufficiency were younger (P = 0.015), were male (P = 0.001), and had kidney disease (P = 0.017) and lower total serum calcium levels (P = 0.003). Hospital mortality was higher in patients with 25(OH)D deficiency (P = 0.01). No differences in ventilator days or length of stay in the MICU were evident among the three groups. Analysis by multiple logistic regression demonstrated that acute physiology and chronic health evaluation (APACHE) IV score ((odds ratio (OR) 1.036; 95% confidence interval (CI) 1.024-1.048, P < 0.0001), ventilator requirement (OR 7.7; 95% CI 4.3-13.98, P < 0.0001), 25(OH) D levels(OR 0.942; 95% CI 0.942-0.904, P < 0.0005) and 25(OH) D deficiency (OR 8.7; 95% CI 1.03-72.8, P < 0.0469) showed statistical significance. There was no association between 25(OH)]D insufficiency and hospital mortality. The mean 25(OH)D level of survivors (27.9 ± 9.7 ng/dL) was higher than for non-survivors (9.7 ± 4.7 ng/dL; P < 0.0001).
The study results demonstrate an association between 25(OH)D deficiency and hospital mortality in MICU patients. A randomized prospective study to evaluate the effect of vitamin D replacement therapy on mortality is warranted.
危重病患者维生素 D 缺乏的发生率据报道低至 17%，高至 79%。关于重症监护病房内 25-羟维生素 D 水平与结局之间关系的数据很少。本研究的目的是评估重症监护病房内 25-羟维生素 D 缺乏的流行情况及其与结局的关系。
这是在一家市区社区医院的内科重症监护病房（MICU）进行的回顾性研究。研究期间为 2009 年 10 月至 2010 年 2 月。
在研究期间收治的 932 例患者中，523 例（53%）有 25-羟维生素 D 维生素 D（25（OH）D）水平；其中 86 例因再次入住重症监护病房而被排除在研究之外。缺乏定义为 0 至 19.9ng/dL 25（OH）D 水平，不足为 20 至 29.9ng/dL，正常水平为≥30ng/dL。在所研究的 437 例患者中，340 例（77.8%）存在 25（OH）D 缺乏，74 例（16.9%）存在不足，23 例（5.3%）患者存在正常水平。25（OH）D 缺乏/不足的患者更年轻（P=0.015），为男性（P=0.001），患有肾脏疾病（P=0.017）和更低的总血清钙水平（P=0.003）。25（OH）D 缺乏的患者住院死亡率更高（P=0.01）。三组之间在呼吸机天数或 MICU 住院时间方面没有差异。多因素 logistic 回归分析表明，急性生理学和慢性健康评估（APACHE）IV 评分（（比值比（OR）1.036；95%置信区间（CI）1.024-1.048，P<0.0001），呼吸机需求（OR 7.7；95%CI 4.3-13.98，P<0.0001），25（OH）D 水平（OR 0.942；95%CI 0.942-0.904，P<0.0005）和 25（OH）D 缺乏（OR 8.7；95%CI 1.03-72.8，P<0.0469）具有统计学意义。25（OH）D 不足与住院死亡率之间没有关联。幸存者的平均 25（OH）D 水平（27.9±9.7ng/dL）高于非幸存者（9.7±4.7ng/dL；P<0.0001）。
研究结果表明，25（OH）D 缺乏与 MICU 患者的住院死亡率有关。需要进行一项随机前瞻性研究来评估维生素 D 替代治疗对死亡率的影响。
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