Anwar Enas, Hamdy Gehan, Taher Eman, Fawzy Esmat, Abdulattif Sherif, Attia Mohamed H
1 Internal Medicine Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
2 Internal Medicine Departments, Faculty of Medicine, Cairo University, Cairo, Egypt.
Nutr Clin Pract. 2017 Jun;32(3):378-384. doi: 10.1177/0884533616671741. Epub 2016 Oct 21.
Vitamin D deficiency is a prevalent condition among critically ill patients. Information about the relationship between vitamin D levels and outcomes in the intensive care unit (ICU) is sparse.
To evaluate vitamin D status among critically ill patients and its relevance to severity of illness, ICU stay period, and mortality.
This prospective multicenter study was conducted in the ICUs of Fayoum, Cairo, Alazhar, and Ain Shams university hospitals. All patients were subjected to interview questionnaire, laboratory investigation, vitamin D level assessment, and severity of illness evaluation using the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score.
In total, 250 patients were included in the study. The median age was 62 (40-73) years, and most patients were male (52%). The median serum level of vitamin D was 19 (7-40.6). Vitamin D was deficient in 197 patients (78.8%) on admission. While we grouped the ICU patients as vitamin D deficient, insufficient, and sufficient, vitamin D-deficient patients had more severe diseases (mean APACHE II score, 44 ± 15; P = .014). Prolonged ICU stay was observed among the deficient group but with no significant association. The overall mortality rate was 6.8%; of these, 70.5% were vitamin D-deficient patients. However, logistic regression analysis demonstrated that vitamin D deficiency was not an independent risk factor for mortality.
Vitamin D insufficiency is common in critically ill patients (69%); it is associated with more severity of illness, but it is not an independent risk factor for longer ICU stay or mortality.
维生素D缺乏在重症患者中普遍存在。关于维生素D水平与重症监护病房（ICU）患者预后之间关系的信息较少。
评估重症患者的维生素D状况及其与疾病严重程度、ICU住院时间和死亡率的相关性。
这项前瞻性多中心研究在法尤姆、开罗、爱资哈尔和艾因夏姆斯大学医院的ICU中进行。所有患者均接受问卷调查、实验室检查、维生素D水平评估，并使用急性生理与慢性健康状况评分系统II（APACHE II）进行疾病严重程度评估。
本研究共纳入250例患者。中位年龄为62（40 - 73）岁，大多数患者为男性（52%）。维生素D的中位血清水平为19（7 - 40.6）。入院时197例患者（78.8%）存在维生素D缺乏。当我们将ICU患者分为维生素D缺乏、不足和充足三组时，维生素D缺乏的患者疾病更严重（平均APACHE II评分为44±15；P = 0.014）。在维生素D缺乏组观察到ICU住院时间延长，但无显著相关性。总死亡率为6.8%；其中，70.5%为维生素D缺乏患者。然而，逻辑回归分析表明维生素D缺乏不是死亡的独立危险因素。
维生素D不足在重症患者中很常见（69%）；它与更严重的疾病相关，但不是ICU住院时间延长或死亡的独立危险因素。
