Pulmonary Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA.
Department of Medicine, Division of Hematology and Oncology, University of Vermont Medical Center and Larner College of Medicine, Burlington, Vermont, USA.
JPEN J Parenter Enteral Nutr. 2019 Nov;43(8):1037-1043. doi: 10.1002/jpen.1520. Epub 2019 Feb 12.
The utility of vitamin D (VITD) supplementation during critical illness and whether it may alter outcomes, including mortality and ventilator-free days, is unclear. We performed a retrospective cohort study in a generalizable population to investigate this question.
We included all mechanically ventilated adults admitted to the medical intensive care unit (ICU) service at a tertiary center from 2009 to 2012 who were in the ICU for at least 72 hours. Patients were grouped as having received or not received VITD at any time during the first 7 days of their ICU stay, and we adjusted for the following covariates with multivariable analyses: simplified acute physiology score, age, gender, admission diagnosis, race/ethnicity, admission season, admission day of the week, and VITD supplementation prior to admission.
Among the 610 included patients, 281 received VITD, and 329 did not. There were no differences in outcomes between these groups. However, we did find significantly more ventilator-free days (21.0±2.6 [adjusted mean days±standard error] vs 17.6±2.4, P=0.04) and ICU-free days (18.5±2.5 vs 16.3±2.3, P=0.03) in patients who were taking VITD prior to admission (n=91) vs those who were not (n=519). No patients who were taking VITD before admission died vs 34.5% of those who were not (estimated odds ratio=4.9×10 , 95% CI=3.1×10 to 7.5×10 , P<0.0001).
These results suggest that VITD supplementation during critical illness may not provide benefit and that further research investigating potential supplementation in ambulatory patients at high risk of ICU admission (eg, severe underlying chronic disease) is warranted.
在危重病期间补充维生素 D（VITD）是否有用，以及它是否可以改变结局，包括死亡率和无呼吸机天数，目前尚不清楚。我们在一个可推广的人群中进行了回顾性队列研究，以调查这个问题。
我们纳入了 2009 年至 2012 年期间在一家三级中心的重症监护病房（ICU）接受机械通气的所有成年患者，这些患者在 ICU 至少住了 72 小时。患者分为在 ICU 入住的前 7 天内任何时间接受或未接受 VITD 治疗的两组，并通过多变量分析调整了以下协变量：简化急性生理学评分、年龄、性别、入院诊断、种族/民族、入院季节、入院周几和入院前 VITD 补充。
在纳入的 610 例患者中，281 例接受了 VITD，329 例未接受。两组的结局没有差异。然而，我们确实发现，在入院前正在服用 VITD（n=91）的患者比未服用 VITD（n=519）的患者有更多的无呼吸机天数（21.0±2.6 [调整后的平均天数±标准误差] vs 17.6±2.4，P=0.04）和无 ICU 天数（18.5±2.5 vs 16.3±2.3，P=0.03）。入院前正在服用 VITD 的患者无一例死亡，而未服用 VITD 的患者中 34.5%死亡（估计比值比=4.9×10，95%置信区间=3.1×10 至 7.5×10，P<0.0001）。
这些结果表明，在危重病期间补充 VITD 可能没有益处，有必要进一步研究在有入住 ICU 高风险的门诊患者（例如严重的基础慢性疾病）中补充 VITD 的潜在作用。
