Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
PLoS One. 2013 Sep 20;8(9):e75441. doi: 10.1371/journal.pone.0075441. eCollection 2013.
Vitamin D deficiency is prevalent in critically ill patients and may contribute to suboptimal clinical outcomes, but little is known about alterations of the calcium-parathyroid hormone (PTH)-vitamin D axis and prognosis in these individuals.
A prospective observational study was conducted on 216 patients admitted to a university-affiliated, tertiary-care medical intensive care unit(MICU) between June 2011 and December 2012. Serum levels of 25-hydroxyvitamin D, ionised calcium and intact PTH were determined within 24 h of MICU admission. The primary end point was all-cause hospital mortality within 90-days of admission.
95 patients (44%) showed 25-hydroxyvitamin D deficiency. Patients deficient in vitamin D showed significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, rate of positive blood culture, incidence of multiple organ dysfunction syndrome, and 90-day mortality rate than did patients with vitamin D insufficiency or sufficiency (P<0.05), as well as lower levels of serum IgG. 25-Hydroxyvitamin D deficiency was identified as an independent risk factor for mortality (OR = 3.018, 95%CI 1.329-6.854, P = 0.008). Hypovitaminosis D in PTH-responders was associated with higher mortality than was the same condition in non-responders (P<0.05).
These results suggest that vitamin D deficiency is prevalent among MICU patients, suggesting a significant derangement of the calcium-PTH-vitamin D axis in critically ill patients. Vitamin D deficiency is an independent risk factor for 90-day mortality, and hypovitaminosis D in PTH-responders is associated with higher mortality than is the same condition in non-responders.
危重症患者普遍存在维生素 D 缺乏，这可能导致临床结局不佳，但人们对这些患者钙-甲状旁腺激素 (PTH)-维生素 D 轴的变化及其预后知之甚少。
对 2011 年 6 月至 2012 年 12 月期间入住一所大学附属医院的三级医疗重症监护病房 (MICU) 的 216 例患者进行了前瞻性观察研究。在入住 MICU 后 24 小时内测定血清 25-羟维生素 D、离子钙和完整 PTH 水平。主要终点为入院后 90 天内的全因住院死亡率。
95 例（44%）患者存在 25-羟维生素 D 缺乏。维生素 D 缺乏的患者的急性生理学和慢性健康评估 II 评分 (APACHE II)、阳性血培养率、多器官功能障碍综合征发生率和 90 天死亡率显著高于维生素 D 不足或充足的患者（P<0.05），且血清 IgG 水平较低。25-羟维生素 D 缺乏是死亡的独立危险因素（OR=3.018，95%CI 1.329-6.854，P=0.008）。PTH 反应者的维生素 D 缺乏症与非反应者相比，死亡率更高（P<0.05）。
这些结果表明，MICU 患者普遍存在维生素 D 缺乏，提示危重症患者钙-PTH-维生素 D 轴存在明显紊乱。维生素 D 缺乏是 90 天死亡率的独立危险因素，PTH 反应者的维生素 D 缺乏症与非反应者相比，死亡率更高。
