Suberviola Borja, Lavin Bernardo Alio, Jimenez Andrés Fernando, Perez-San Martin Sonia, Garcia-Unzueta Maite, Santibañez Miguel
Intensive Care Department, University Hospital Marqués de Valdecilla-IDIVAL, Avenida de Valdecilla SN 39008, Santander, Spain.
Department of Clinical Biochemistry, University Hospital Marqués de Valdecilla-IDIVAL, Avenida de Valdecilla SN 39008, Santander, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2019 Apr;37(4):239-243. doi: 10.1016/j.eimc.2018.06.011. Epub 2018 Nov 20.
The aim of this study was to assess the prognostic value of vitamin D, vitamin D binding protein (VDBP) and vitamin D-related peptides in septic shock patients in relation to hospital mortality.
This is a single-center, prospective, observational study that included all consecutive patients meeting criteria for septic shock who were admitted to the ICU. VDBP, 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, cathelicidin and beta-defensin levels were determined in blood samples obtained on admission to the ICU.
Seventy-five patients were studied. The best area under the curve (AUC) for prediction of in-hospital mortality was for VDBP (0.78), with a negative predictive value of 85.45% for the optimal cut-off point. VDBP was also the only variable that had a statistically significant association with a higher risk of in-hospital mortality, regardless of other assessed variables and pre-determined confounders: adjusted odds ratio of 5.20 (95% confidence interval: 1.21-22.36). When restricted to patients with vitamin D insufficiency (n=54), the AUC was 0.77, and the adjusted OR 12.22 (95% CI: 1.46-102.14; p=0.021) for in-hospital mortality.
VDBP levels showed a statistically significant association with in-hospital mortality, supporting the clinical utility of VDBP as a good prognostic marker in septic shock patients. Vitamin D and vitamin D-related peptides are not associated with in-hospital mortality. These results should be confirmed in a multicentre study with a larger sample size.
本研究旨在评估维生素D、维生素D结合蛋白（VDBP）和维生素D相关肽对感染性休克患者医院死亡率的预后价值。
这是一项单中心、前瞻性观察性研究，纳入了所有入住重症监护病房（ICU）且符合感染性休克标准的连续患者。在患者入住ICU时采集的血样中测定VDBP、25-羟基维生素D、1,25-二羟基维生素D、杀菌肽和β-防御素水平。
共研究了75例患者。预测医院死亡率的曲线下面积（AUC）最佳的是VDBP（0.78），其最佳切点的阴性预测值为85.45%。VDBP也是唯一一个与医院死亡风险较高具有统计学显著关联的变量，无论其他评估变量和预先确定的混杂因素如何：调整后的优势比为5.20（95%置信区间：1.21 - 22.36）。当仅限于维生素D不足的患者（n = 54）时，AUC为0.77，医院死亡率的调整后OR为12.22（95%CI：1.46 - 102.14；p = 0.021）。
VDBP水平与医院死亡率具有统计学显著关联，支持VDBP作为感染性休克患者良好预后标志物的临床应用价值。维生素D和维生素D相关肽与医院死亡率无关。这些结果应在样本量更大的多中心研究中得到证实。
