Ernst Jana B, Becker Tobias, Kuhn Joachim, Gummert Jan F, Zittermann Armin
Clinic for Thoracic and Cardiovascular Surgery Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
PLoS One. 2015 Apr 17;10(4):e0124751. doi: 10.1371/journal.pone.0124751. eCollection 2015.
Preoperative anemia is considered an independent risk factor of poor clinical outcome in cardiac surgical patients. Low vitamin D status may increase anemia risk.
We investigated 3,615 consecutive patients scheduled for cardiac surgery to determine the association between preoperative anemia (hemoglobin [Hb] <12.5 g/dL) and circulating levels of the vitamin D metabolites 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25[OH]2D).
Of the study cohort, 27.8 % met the criteria for anemia. In patients with deficient 25OHD levels (<30 nmol/l) mean Hb concentrations were 0.5 g/dL lower than in patients with adequate 25OHD levels (50.0-125 nmol/l; P<0.001). Regarding 1,25(OH)2D, mean Hb concentrations were 1.2 g/dL lower in the lowest 1,25(OH)2D category (<40 pmol/l) than in the highest 1,25(OH)2D category (>70 pmol/l; P<0.001). In multivariable-adjusted logistic regression analyses, the odds ratios for anemia of the lowest categories of 25OHD and 1,25(OH)2D were 1.48 (95%CI:1.19-1.83) and 2.35 (95%CI:1.86-2.97), compared with patients who had adequate 25OHD levels and 1,25(OH)2D values in the highest category, respectively. Anemia risk was greatest in patients with dual deficiency of 25OHD and 1,25(OH)2D (multivariable-adjusted OR = 3.60 (95%CI:2.40-5.40). Prevalence of deficient 25OHD levels was highest in anemia of nutrient deficiency, whereas low 1,25(OH)2D levels were most frequent in anemia of chronic kidney disease.
This cross-sectional study demonstrates an independent inverse association between vitamin D status and anemia risk. If confirmed in clinical trials, preoperative administration of vitamin D or activated vitamin D (in case of chronic kidney disease) would be a promising strategy to prevent anemia in patients scheduled for cardiac surgery.
术前贫血被认为是心脏手术患者临床预后不良的独立危险因素。维生素D水平低可能会增加贫血风险。
我们调查了3615例连续接受心脏手术的患者，以确定术前贫血（血红蛋白[Hb]<12.5 g/dL）与维生素D代谢产物25-羟基维生素D（25OHD）和1,25-二羟基维生素D（1,25[OH]2D）循环水平之间的关联。
在研究队列中，27.8%符合贫血标准。25OHD水平不足（<30 nmol/l）的患者平均Hb浓度比25OHD水平充足（50.0 - 125 nmol/l）的患者低0.5 g/dL（P<0.001）。关于1,25(OH)2D，1,25(OH)2D最低类别（<40 pmol/l）的患者平均Hb浓度比最高类别（>70 pmol/l）的患者低1.2 g/dL（P<0.001）。在多变量调整的逻辑回归分析中，与25OHD水平充足且1,25(OH)2D值处于最高类别的患者相比，25OHD和1,25(OH)2D最低类别的贫血比值比分别为1.48（95%CI：1.19 - 1.83）和2.35（95%CI：1.86 - 2.97）。25OHD和1,25(OH)2D双重缺乏的患者贫血风险最大（多变量调整OR = 3.60（95%CI：2.40 - 5.40））。营养缺乏性贫血患者中25OHD水平不足的患病率最高，而慢性肾脏病贫血患者中1,25(OH)2D水平低最为常见。
这项横断面研究表明维生素D状态与贫血风险之间存在独立的负相关。如果在临床试验中得到证实，术前给予维生素D或活性维生素D（对于慢性肾脏病患者）将是预防心脏手术患者贫血的一种有前景的策略。
