Barbonetti Arcangelo, D'Andrea Settimio, Martorella Alessio, Felzani Giorgio, Francavilla Sandro, Francavilla Felice
Spinal Unit, San Raffaele Sulmona Institute, Sulmona, AQ, Italy.
Department of Life, Health and Environment Sciences, Andrology Unit, University of L'Aquila, L'Aquila, AQ, Italy.
Spinal Cord. 2018 May;56(5):494-501. doi: 10.1038/s41393-017-0058-7. Epub 2018 Jan 16.
Longitudinal cohort study.
To explore the longitudinal association of baseline vitamin D levels with 1-year change in physical function outcomes in people with chronic spinal cord injury (SCI).
Rehabilitation institute.
Sixty-seven patients (44 men and 23 women) with chronic SCI admitted to a rehabilitation program were included. Functional independence in daily living activities (as evaluated by the Spinal Cord Independence Measure version III, SCIM III) and leisure time physical activity (LTPA) were assessed as measures of physical function at the admission and re-assessed 1-year later. Comorbidity was scored by Charlson comorbidity index (CCI).
A 1-year worsening in SCIM and LTPA were registered in 44 and 40 patients (66% and 60% of the study population), respectively. They exhibited significantly lower baseline 25(OH)D levels, higher CCI, and shorter distance from the injury. At the multiple linear regression analyses, lower baseline 25(OH)D levels exhibited a significant independent association with higher percentages of 1-year worsening in both SCIM and LTPA. At ROC analysis, baseline 25(OH)D levels <18.6 and <18.2 ng/mL discriminated individuals with 1-year worsening in SCIM and LTPA, respectively. According to these cut-off points, at the multiple logistic regression analysis, patients with low baseline 25(OH)D levels exhibited an OR of worsening in SCIM and LTPA engagement 2.8- and 2.6-fold higher, after adjustment for CCI, distance from injury, and post-follow-up 25(OH)D levels.
In people with chronic SCI, a low 25(OH)D level may represent an independent predictor of worsening in physical function outcomes over time.
纵向队列研究。
探讨慢性脊髓损伤（SCI）患者基线维生素D水平与身体功能结局1年变化的纵向关联。
康复机构。
纳入67例参加康复项目的慢性SCI患者（44例男性和23例女性）。将日常生活活动中的功能独立性（通过脊髓独立性评定量表第三版，SCIM III评估）和休闲时间身体活动（LTPA）作为入院时身体功能的指标，并在1年后重新评估。合并症采用Charlson合并症指数（CCI）评分。
44例和40例患者（分别占研究人群的66%和60%）的SCIM和LTPA在1年内出现恶化。他们的基线25（OH）D水平显著较低，CCI较高，且受伤时间较短。在多元线性回归分析中，较低的基线25（OH）D水平与SCIM和LTPA中1年恶化百分比的升高存在显著独立关联。在ROC分析中基线25（OH）D水平<18.6和<18.2 ng/mL分别可区分SCIM和LTPA在1年内出现恶化的个体。根据这些切点，在多元逻辑回归分析中，调整CCI、受伤时间和随访后25（OH）D水平后，基线25（OH）D水平低的患者在SCIM和LTPA参与度恶化方面的OR分别高2.8倍和2.6倍。
在慢性SCI患者中，低25（OH）D水平可能是身体功能结局随时间恶化的独立预测因素。
