Division of Endocrinology and Metabolism (K.A.), Department of Internal Medicine, and Division of Endocrinology and Metabolism (T.R.P.), Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; Department of Anesthesia, Critical Care, and Pain Medicine (S.A.Q.), Division of Pulmonary and Critical Care Medicine (F.K.G.), Department of Medicine, and Department of Emergency Medicine (C.A.C.), Massachusetts General Hospital, Boston, Massachusetts 02114; Channing Division of Network Medicine and Pulmonary and Critical Care Division (A.A.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115; and Departments of Nutrition and Epidemiology (E.G.), Harvard School of Public Health, and The Nathan E. Hellman Memorial Laboratory (K.B.C.), Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
J Clin Endocrinol Metab. 2014 Apr;99(4):1461-9. doi: 10.1210/jc.2013-3481. Epub 2014 Jan 13.
The objective of the study was to examine the association between prehospital serum 25-hydroxyvitamin D [25(OH)D]and the risk of mortality after hospital admission.
We performed a retrospective cohort study of adults hospitalized for acute care between 1993 and 2011.
The study was conducted at two Boston teaching hospitals.
A total of 24,094 adult inpatients participated in the study.
There was no intervention.
All patients had serum 25(OH)D measured before hospitalization. The exposure of interest was 25(OH)D categorized as less than 10 ng/mL, 10-19.9 ng/mL, 20-29.9 ng/mL, 30-49.9 ng/mL, 50-59.9 ng/mL, 60-69.9 ng/mL, and 70 ng/mL or greater. The main outcome measure was 90-day mortality. Adjusted odds ratios (ORs) were estimated by multivariable logistic regression with inclusion of potential confounders.
After adjustment for age, gender, race (white vs nonwhite), patient type (surgical vs medical), season of 25(OH)D draw, and the Deyo-Charlson index, patients with 25(OH)D levels less than 30 ng/mL or 60 ng/mL or greater had higher odds of 90-day mortality compared with patients with levels of 30-49.9 ng/mL [adjusted OR (95% confidence interval) for 25(OH)D <10 ng/mL, 10-19.9 ng/mL, 20-29.9 ng/mL, 50-59.9 ng/mL, 60-69.9 ng/mL, and ≥70 ng/mL was 2.01 (1.68-2.40), 1.89 (1.64-2.18), 1.34 (1.16-1.56), 0.94 (0.69-1.26), 1.52 (1.03-2.25), and 1.69 (1.09-2.61), respectively, compared with patients with 25(OH)D levels 30-49.9 ng/mL].
A causal relationship between either low or high 25(OH)D levels and increased mortality can not necessarily be inferred from this observational study.
Analysis of 24 094 adult patients showed that 25(OH)D levels less than 20 ng/mL and 60 ng/mL or greater before hospitalization were associated with an increased odds of 90-day mortality. Although previous reports have suggested an association between low vitamin D status and mortality, these data raise the issue of potential harm from high serum 25(OH)D levels, provide a rationale for an upper limit to supplementation, and emphasize the need for caution in the use of extremely high doses of vitamin D among patients.
本研究旨在探讨入院前血清 25-羟维生素 D [25（OH）D] 与住院后死亡率之间的关系。
我们对 1993 年至 2011 年间因急性护理住院的成年人进行了回顾性队列研究。
该研究在波士顿的两家教学医院进行。
共有 24094 名成年住院患者参与了这项研究。
无干预措施。
所有患者在入院前均检测血清 25（OH）D。感兴趣的暴露是 25（OH）D 分为<10ng/mL、10-19.9ng/mL、20-29.9ng/mL、30-49.9ng/mL、50-59.9ng/mL、60-69.9ng/mL 和 70ng/mL 或更高。主要观察指标为 90 天死亡率。通过多变量逻辑回归估计调整后的比值比（OR），并纳入潜在混杂因素。
在调整年龄、性别、种族（白种人 vs 非白种人）、患者类型（手术 vs 内科）、25（OH）D 采血季节和 Deyo-Charlson 指数后，25（OH）D 水平<30ng/mL 或 60ng/mL 或更高的患者 90 天死亡率较高与 25（OH）D 水平为 30-49.9ng/mL 的患者相比[25（OH）D<10ng/mL、10-19.9ng/mL、20-29.9ng/mL、50-59.9ng/mL、60-69.9ng/mL 和≥70ng/mL 的调整后 OR（95%置信区间）分别为 2.01（1.68-2.40）、1.89（1.64-2.18）、1.34（1.16-1.56）、0.94（0.69-1.26）、1.52（1.03-2.25）和 1.69（1.09-2.61）]。
从这项观察性研究中，不能必然推断出低或高 25（OH）D 水平与死亡率增加之间存在因果关系。
对 24094 名成年患者的分析表明，入院前 25（OH）D 水平<20ng/mL 和 60ng/mL 或更高与 90 天死亡率增加有关。尽管之前的报告表明维生素 D 状态低与死亡率有关，但这些数据提出了高血清 25（OH）D 水平可能带来危害的问题，为补充剂设定了上限，并强调了在患者中使用极高剂量维生素 D 时需要谨慎。
