Holter Jan C, Ueland Thor, Norseth Jon, Brunborg Cathrine, Frøland Stig S, Husebye Einar, Aukrust Pål, Heggelund Lars
Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
PLoS One. 2016 Jul 1;11(7):e0158536. doi: 10.1371/journal.pone.0158536. eCollection 2016.
Low vitamin D status has been associated with short-term (30-day) mortality in hospitalized adults with community-acquired pneumonia (CAP). Data on its prevalence in these patients are scarce, and impact on long-term prognosis is unknown. We examined the prevalence of vitamin D deficiency and inadequacy and their effect on long-term mortality in hospitalized adults with CAP.
Secondary follow-up analysis of data from a prospectively recruited (January 2008-January 2011) well-defined cohort of 241 hospital survivors of CAP (Norway, latitude 60°N). Serum 25-hydroxyvitamin D levels, demographic, clinical, and laboratory data were measured within 48 hours of admission. The etiology of CAP was established in 63% of patients through extensive microbiological investigations. Mortality data were obtained from the national Cause of Death Registry. Explanatory strategy and Cox regression models were used to explore the association between vitamin D status and all-cause mortality.
Median age was 66 years. Eighty-seven (36%) patients were vitamin D deficient (<30 nmol/L), 81 (34%) were inadequate (30-49 nmol/L), and 73 (30%) were sufficient (≥50 nmol/L). Seventy-two patients died over a median of 1839 days (range 1-2520 days), corresponding to cumulative 5-year survival rates of 66.2% (95% CI 56.2-76.2%), 77.0% (67.6-86.4%), and 77.8% (67.8-87.8%) for vitamin D deficient, inadequate, and sufficient patients, respectively. After adjusting for confounders (age, chronic obstructive pulmonary disease, immunocompromization and season), vitamin D deficiency, but not inadequacy, was significantly associated with higher mortality compared to patients with sufficiency (HR 1.91, 95% CI 1.06-3.45; P = .031).
There is a high prevalence of vitamin D deficiency and inadequacy among hospitalized adults with CAP. The results of this study also suggest that vitamin D deficiency is associated with an increased risk of mortality way beyond the short-term in these patients.
维生素D水平低与社区获得性肺炎（CAP）住院成人的短期（30天）死亡率相关。关于这些患者中维生素D缺乏症患病率的数据很少，其对长期预后的影响尚不清楚。我们研究了维生素D缺乏和不足的患病率及其对CAP住院成人长期死亡率的影响。
对前瞻性招募（2008年1月至2011年1月）的241例CAP住院幸存者（挪威，北纬60°）的明确队列数据进行二次随访分析。入院后48小时内测量血清25-羟维生素D水平、人口统计学、临床和实验室数据。通过广泛的微生物学调查确定了63%患者的CAP病因。死亡率数据来自国家死亡原因登记处。采用解释性策略和Cox回归模型探讨维生素D状态与全因死亡率之间的关联。
中位年龄为66岁。87例（36%）患者维生素D缺乏（<30 nmol/L），81例（34%）不足（30 - 49 nmol/L），73例（30%）充足（≥50 nmol/L）。72例患者在中位1839天（范围1 - 2520天）内死亡，维生素D缺乏、不足和充足的患者5年累积生存率分别为66.2%（95%CI 56.2 - 76.2%）、77.0%（67.6 - 86.4%）和77.8%（67.8 - 87.8%）。在调整混杂因素（年龄、慢性阻塞性肺疾病、免疫功能低下和季节）后，与充足的患者相比，维生素D缺乏而非不足与更高的死亡率显著相关（HR 1.91，95%CI 1.06 - 3.45；P = 0.031）。
CAP住院成人中维生素D缺乏和不足的患病率很高。这项研究的结果还表明，维生素D缺乏与这些患者短期以外的死亡率增加风险相关。
