Renal Division, Brigham and Women's Hospital, Boston, MA, USA.
Crit Care Med. 2012 Dec;40(12):3170-9. doi: 10.1097/CCM.0b013e318260c928.
Given the importance of inflammation in acute kidney injury and the relationship between vitamin D and inflammation, we sought to elucidate the effect of vitamin D on acute kidney injury. We hypothesized that deficiency in 25-hydroxyvitamin D prior to hospital admission would be associated with acute kidney injury in the critically ill.
Two-center observational study of patients treated in medical and surgical intensive care units.
Two hundred nine medical and surgical intensive care beds in two teaching hospitals in Boston, Massachusetts.
Two thousand seventy-five patients, aged ≥ 18 yrs, in whom serum 25-hydroxyvitamin D was measured prior to hospitalization between 1998 and 2009.
: None.
The exposure of interest was preadmission serum 25-hydroxyvitamin D and categorized a priori as deficiency (25-hydroxyvitamin D <15 ng/mL), insufficiency (25-hydroxyvitamin D 15-30 ng/mL), or sufficiency (25-hydroxyvitamin D ≥ 30 ng/mL). The primary outcome was acute kidney injury defined as meeting Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) Injury or Failure criteria. Logistic regression examined the RIFLE criteria outcome. Adjusted odds ratios were estimated by multivariate logistic regression models. Preadmission 25-hydroxyvitamin D deficiency is predictive of acute kidney injury. Patients with 25-hydroxyvitamin D deficiency have an odds ratio for acute kidney injury of 1.73 (95% confidence interval 1.30-2.30; p < .0001) relative to patients with 25-hydroxyvitamin D sufficiency. 25-Hydroxyvitamin D deficiency remains a significant predictor of acute kidney injury following multivariable adjustment (adjusted odds ratio 1.50; 95% confidence interval 1.42-2.24; p < .0001). Patients with 25-hydroxyvitamin D insufficiency have an odds ratio for acute kidney injury of 1.49 (95% confidence interval 1.15-1.94; p = .003) and an adjusted odds ratio of 1.23 (95% confidence interval 1.12-1.72; p = .003) relative to patients with 25-hydroxyvitamin D sufficiency. In addition, preadmission 25-hydroxyvitamin D deficiency is predictive of mortality. Patients with 25-hydroxyvitamin D insufficiency have an odds ratio for 30-day mortality of 1.60 (95% confidence interval 1.18-2.17; p = .003) and an adjusted odds ratio of 1.61 (95% confidence interval 1.06-1.57; p = .004) relative to patients with 25-hydroxyvitamin D sufficiency.
Deficiency of 25-hydroxyvitamin D prior to hospital admission is a significant predictor of acute kidney injury and mortality in a critically ill patient population.
鉴于炎症在急性肾损伤中的重要性以及维生素 D 与炎症之间的关系，我们试图阐明维生素 D 对急性肾损伤的影响。我们假设，入院前 25-羟维生素 D 缺乏与危重病患者的急性肾损伤有关。
在马萨诸塞州波士顿的两家教学医院的内科和外科重症监护病房进行的两项中心观察性研究。
209 张内科和外科重症监护病床。
2075 名年龄≥18 岁的患者，在 1998 年至 2009 年间入院前测量血清 25-羟维生素 D。
无。
感兴趣的暴露是入院前血清 25-羟维生素 D，并预先分为缺乏（25-羟维生素 D<15ng/ml）、不足（25-羟维生素 D15-30ng/ml）或充足（25-羟维生素 D≥30ng/ml）。主要结局是符合风险、损伤、衰竭、损失和终末期肾病（RIFLE）损伤或衰竭标准的急性肾损伤。逻辑回归检查了 RIFLE 标准结果。通过多变量逻辑回归模型估计调整后的优势比。入院前 25-羟维生素 D 缺乏与急性肾损伤相关。与 25-羟维生素 D 充足的患者相比，25-羟维生素 D 缺乏的患者发生急性肾损伤的优势比为 1.73（95%置信区间 1.30-2.30；p<0.0001）。在多变量调整后，25-羟维生素 D 缺乏仍然是急性肾损伤的显著预测因子（调整优势比 1.50；95%置信区间 1.42-2.24；p<0.0001）。25-羟维生素 D 不足的患者发生急性肾损伤的优势比为 1.49（95%置信区间 1.15-1.94；p=0.003），调整后的优势比为 1.23（95%置信区间 1.12-1.72；p=0.003），与 25-羟维生素 D 充足的患者相比。此外，入院前 25-羟维生素 D 缺乏与死亡率相关。25-羟维生素 D 不足的患者 30 天死亡率的优势比为 1.60（95%置信区间 1.18-2.17；p=0.003），调整后的优势比为 1.61（95%置信区间 1.06-1.57；p=0.004），与 25-羟维生素 D 充足的患者相比。
入院前 25-羟维生素 D 缺乏是危重病患者急性肾损伤和死亡率的重要预测因素。
