25(OH) 维生素 D 与康复单元老年患者的功能结局：Safari 研究。

25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study.

机构信息

Area di Geriatria, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.

Parc Sanitari Pere Virgili, Barcelona, Spain.

出版信息

Osteoporos Int. 2019 Apr;30(4):887-895. doi: 10.1007/s00198-019-04845-7. Epub 2019 Jan 16.

DOI:10.1007/s00198-019-04845-7

PMID:30652217

Abstract

UNLABELLED

Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population.

INTRODUCTION

Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units.

METHODS

We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models.

RESULTS

We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5-18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]).

CONCLUSIONS

In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.

摘要

目的

维生素 D（25（OH）D）缺乏与身体机能较差有关；但关于其对老年康复的影响知之甚少。我们发现 25（OH）D 与功能增益之间存在正的非线性关系，在低于 16ng/ml（低于“缺乏”的截止值）的水平下更强。对于这一人群，早期进行 25（OH）D 剂量可能是明智的。

方法

我们进行了一项前瞻性多中心队列研究，纳入了意大利和西班牙 3 家老年康复单位因骨科事件或中风而入院的年龄≥65 岁的患者。结果为出院-入院 Barthel 指数（绝对功能增益，AFG）和入院后 3 个月时的行走能力（AW）。使用线性或逻辑回归模型探索 25（OH）D 四分位（Q1-Q2-Q3-Q4）与结局之间的关系。