维生素D缺乏作为危重症患者感染、脓毒症及死亡的危险因素：系统评价与荟萃分析
Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis.
作者信息
de Haan Kim, Groeneveld A B Johan, de Geus Hilde R H, Egal Mohamud, Struijs Ard
机构信息
Department of Intensive Care, Erasmus Medical Centre, Mailbox 2040, H603a, 3000CA, Rotterdam, The Netherlands.
Department of Intensive Care, Erasmus Medical Centre, Mailbox 2040, H603, 3000CA, Rotterdam, The Netherlands.
出版信息
Crit Care. 2014 Dec 5;18(6):660. doi: 10.1186/s13054-014-0660-4.
INTRODUCTION
In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in the healthy general adult population. The consequences of vitamin D deficiency for sepsis and outcome in critically ill patients remain controversial. We therefore systematically reviewed observational cohort studies on vitamin D deficiency in the intensive care unit.
METHODS
Fourteen observational reports published from January 2000 to March 2014, retrieved from Pubmed and Embase, involving 9,715 critically ill patients and serum 25-hydroxyvitamin D3 (25 (OH)-D) concentrations, were meta-analysed.
RESULTS
Levels of 25 (OH)-D less than 50 nmol/L were associated with increased rates of infection (risk ratio (RR) 1.49, 95% (confidence interval (CI) 1.12 to 1.99), P = 0.007), sepsis (RR 1.46, 95% (CI 1.27 to 1.68), P <0.001), 30-day mortality (RR 1.42, 95% (CI 1.00 to 2.02), P = 0.05), and in-hospital mortality (RR 1.79, 95% (CI 1.49 to 2.16), P <0.001). In a subgroup analysis of adjusted data including vitamin D deficiency as a risk factor for 30-day mortality the pooled RR was 1.76 (95% CI 1.37 to 2.26, P <0.001).
CONCLUSIONS
This meta-analysis suggests that vitamin D deficiency increases susceptibility for severe infections and mortality of the critically ill.
引言
在欧洲，维生素D缺乏症极为普遍，健康成年人群中的患病率在40%至60%之间。维生素D缺乏对脓毒症及重症患者预后的影响仍存在争议。因此，我们系统回顾了重症监护病房中关于维生素D缺乏的观察性队列研究。
方法
从PubMed和Embase数据库中检索出2000年1月至2014年3月发表的14篇观察性报告，涉及9715例重症患者及血清25-羟基维生素D3（25(OH)-D）浓度，并进行荟萃分析。
结果
25(OH)-D水平低于50 nmol/L与感染率增加（风险比（RR）1.49，95%置信区间（CI）1.12至1.99，P = 0.007）、脓毒症（RR 1.46，95% CI 1.27至1.68，P <0.001）、30天死亡率（RR 1.42，95% CI 1.00至2.02，P = 0.05）及住院死亡率（RR 1.79，95% CI 1.49至2.16，P <0.001）相关。在一项将维生素D缺乏作为30天死亡率风险因素的校正数据亚组分析中，合并RR为1.76（95% CI 1.37至2.26，P <0.001）。
结论
这项荟萃分析表明，维生素D缺乏会增加重症患者发生严重感染的易感性及死亡率。
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