Department of Anesthesiology and Critical Care, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Sci Rep. 2018 Feb 14;8(1):2965. doi: 10.1038/s41598-018-21177-4.
To evaluate the association of admission serum levels of 25(OH)D, parathormone and the related electrolytes with severity of illness and clinical outcomes in neurosurgical critically ill patients, serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate, along with APACHE II score were measured for 210 patients upon admission. Mean serum 25(OH)D was 21.1 ± 7.4 ng/mL. 25(OH)D deficiency (less than 20 ng/dL) and elevated serum parathormone level were found in 47.6% and 38% of patients respectively. Hypocalcaemia, hypophosphatemia, hypomagnesaemia and hypermagnesaemia were found in 29.5%, %63.8, 41.9% and 27.6% of patients respectively. The APACHE II score was significantly correlated with serum levels of 25(OH)D, parathormone, calcium, and phosphate. Multivariate regression analysis adjusted by other risk factors showed that among all clinical outcomes, admission hypovitaminosis D was associated with longer duration of ICU stay and a high admission of parathormone was associated with in ICU mortality. We concluded that disorders of admission serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate are related to the presence of multiple causal factors such as severity of disease and are not independently associated with clinical outcomes. Most often they are normalize spontaneously with resolution of the disease process.
为了评估神经外科危重症患者入院时血清 25（OH）D、甲状旁腺激素和相关电解质水平与疾病严重程度和临床结局的关系，对 210 例患者入院时的血清 25（OH）D、甲状旁腺激素、钙、镁和磷水平以及急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）进行了检测。平均血清 25（OH）D 为 21.1±7.4ng/ml。分别有 47.6%和 38%的患者存在 25（OH）D 缺乏（＜20ng/dl）和甲状旁腺激素水平升高。低钙血症、低磷血症、低镁血症和高镁血症在患者中的发生率分别为 29.5%、63.8%、41.9%和 27.6%。APACHEⅡ评分与血清 25（OH）D、甲状旁腺激素、钙和磷水平显著相关。多因素回归分析校正其他危险因素后发现，在所有临床结局中，入院时维生素 D 缺乏与 ICU 住院时间延长有关，而入院时甲状旁腺激素升高与 ICU 死亡率有关。我们的结论是，入院时血清 25（OH）D、甲状旁腺激素、钙、镁和磷水平的紊乱与疾病严重程度等多种因果因素有关，与临床结局无独立关系。大多数情况下，随着疾病过程的缓解，这些水平会自动恢复正常。
