Joshi Ameya, Bhadade Rakesh, Varthakavi Premlata K, DeSouza Rosmarie, Bhagwat Nikhil M, Chadha Manoj D
Department of Endocrinology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India.
Department of Medicine, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India.
Indian J Endocrinol Metab. 2014 Jul;18(4):511-5. doi: 10.4103/2230-8210.137504.
Vitamin D (VitD) classically recognized for its role in the musculoskeletal system, has been implicated in myriad of conditions such as diabetes, immune dysfunction, cancers, heart disease, metabolic syndrome, etc. We studied the role of VitD in acute care setting and its correlation with mortality.
A total of 85 consecutive consenting patients admitted in medical intensive care unit of tertiary care hospital who fulfilled the inclusion criteria were included. All patients were evaluated clinically, and blood samples were collected for hemogram, biochemical investigations including serum calcium, phosphorus, alkaline phosphatase, magnesium, along with 25(OH) VitD, 1,25(OH) VitD and intact parathormone levels. Simplified acute physiology score (SAPS II) was calculated for all patients.
VitD was deficient (<30 ng/ml) in 27 patients (32%). The overall mortality was more in VitD deficient group as compared to VitD sufficient group (74 vs. 41%; P < 0.05). The actual mortality in VitD deficient group was higher than the mortality predicted by SAPS II score (50 vs. 74%; P < 0.0507). VitD deficiency was also associated with more mortality among those requiring ventilator support (95% vs. 40%; P < 0.05) as well as with higher blood glucose (124.5 ± 29.7 vs. 94.8 ± 19.8: P < 0.01) levels.
VitD deficiency was associated with increased mortality, poor ventilator outcomes, and increased blood glucose in critically ill patients.
维生素D(VitD)传统上因其在肌肉骨骼系统中的作用而被认可,现被认为与多种疾病有关,如糖尿病、免疫功能障碍、癌症、心脏病、代谢综合征等。我们研究了VitD在急性护理环境中的作用及其与死亡率的相关性。
纳入了一家三级护理医院医学重症监护病房中连续85例符合纳入标准并同意参与研究的患者。所有患者均接受临床评估,并采集血样进行血常规、生化检查,包括血清钙、磷、碱性磷酸酶、镁,以及25(OH)VitD、1,25(OH)VitD和完整甲状旁腺激素水平。为所有患者计算简化急性生理学评分(SAPS II)。
27例患者(32%)存在VitD缺乏(<30 ng/ml)。与VitD充足组相比,VitD缺乏组的总体死亡率更高(74%对41%;P<0.05)。VitD缺乏组的实际死亡率高于SAPS II评分预测的死亡率(50%对74%;P<0.0507)。VitD缺乏还与需要呼吸机支持的患者中更高的死亡率相关(95%对40%;P<0.05),以及更高的血糖水平相关(124.5±29.7对94.8±19.8:P<0.01)。
VitD缺乏与危重症患者死亡率增加、呼吸机治疗效果不佳和血糖升高有关。