低维生素 D 水平是艰难梭菌相关性腹泻不良结局的独立预测因子。
Low vitamin D level is an independent predictor of poor outcomes in Clostridium difficile-associated diarrhea.
机构信息
Department of Gastroenterology, New York Hospital Queens/Weill Cornell Medical College, 56-45 Main Street, Flushing, NY 11355, USA.
Department of Medicine, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA.
出版信息
Therap Adv Gastroenterol. 2014 Jan;7(1):14-9. doi: 10.1177/1756283X13502838.
BACKGROUND
The incidence, recurrence, and all-cause mortality rate for Clostridium difficile-associated diarrhea (CDAD) has increased markedly over the past 10 years despite treatment. Low vitamin D levels are known to impair immune responses to infection and are associated with increased mortality. We compared the role of patient comorbidity measured by the Charlson Comorbidity Index (CCI) with vitamin D levels to ascertain whether vitamin D levels were an independent variable affecting the outcome of CDAD or a marker of overall comorbidity.
METHODS
A prospective cohort study studied 62 patients hospitalized between 2008 and 2009 with manifestations of CDAD and a positive C. difficile toxin assay. All patients received standard antibiotics (metronidazole and/or vancomycin). Their status at 30-day follow up was classified as resolved or recurred/expired. Patients' CCI was calculated using their medical history. Logistic regression analysis of variables including 25-hydroxyvitamin D, CCI, age, gender, white blood cell count (WBC), albumin and residence type were performed.
RESULTS
There were 62 patients (43.6% men, 56.4% women) with CDAD; mean age was 75 ± 17 years. At 30-day follow up, 28 (45.2%) expired, 10 (16.1%) had persistent or recurrent diarrhea and 24 (38.7%) resolved. Nonresolution was seen in 38 (61.3%). There was no significant association between 30-day resolution status and CCI, gender, WBC, albumin level or residence type. Two variables were found to be independent predictors of resolution of CDAD: normal vitamin D levels (p = 0.028) and age <70 years (p = 0.024). Subjects with low vitamin D were 4.75 times more likely to fail to resolve CDAD than subjects with normal Vitamin D.
CONCLUSION
In this study, vitamin D level and age are independent predictors of CDAD resolution in hospitalized patients. Low vitamin D levels and age >70 years old are associated with increased likelihood of recurrence. Low vitamin D levels are not a marker of comorbidity or advanced age.
背景
尽管进行了治疗，但艰难梭菌相关性腹泻（CDAD）的发病率、复发率和全因死亡率在过去 10 年中显著增加。已知低维生素 D 水平会损害对感染的免疫反应，并与死亡率增加相关。我们比较了 Charlson 合并症指数（CCI）衡量的患者合并症与维生素 D 水平的作用，以确定维生素 D 水平是否是影响 CDAD 结局的独立变量，还是整体合并症的标志物。
方法
一项前瞻性队列研究对 2008 年至 2009 年间出现 CDAD 表现和阳性艰难梭菌毒素检测的 62 名住院患者进行了研究。所有患者均接受标准抗生素（甲硝唑和/或万古霉素）治疗。在 30 天随访时，将患者的情况分为已解决或复发/死亡。使用患者的病史计算 CCI。对包括 25-羟维生素 D、CCI、年龄、性别、白细胞计数（WBC）、白蛋白和居住类型在内的变量进行逻辑回归分析。
结果
有 62 名（43.6%为男性，56.4%为女性）患者患有 CDAD；平均年龄为 75 ± 17 岁。在 30 天随访时，28 例（45.2%）死亡，10 例（16.1%）持续性或复发性腹泻，24 例（38.7%）缓解。未缓解的有 38 例（61.3%）。30 天缓解状态与 CCI、性别、WBC、白蛋白水平或居住类型之间无显著关联。有两个变量被发现是 CDAD 缓解的独立预测因素：正常的维生素 D 水平（p=0.028）和年龄<70 岁（p=0.024）。维生素 D 水平低的患者比维生素 D 正常的患者更不可能缓解 CDAD，风险比为 4.75 倍。
结论
在这项研究中，维生素 D 水平和年龄是住院患者 CDAD 缓解的独立预测因素。低维生素 D 水平和年龄>70 岁与复发的可能性增加相关。低维生素 D 水平不是合并症或高龄的标志物。
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