Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
Shock. 2020 Jun;53(6):717-722. doi: 10.1097/SHK.0000000000001441.
Vitamin D deficiency is associated with various cardiovascular diseases, including sudden cardiac arrest (SCA). Profound cardiogenic shock is associated with morbidity and mortality in patients with SCA. This study investigated the association of vitamin D deficiency with profound cardiogenic shock in patients resuscitated from SCA.
We enrolled patients who were successfully resuscitated from out-of-hospital cardiac arrests of a presumed cardiac cause. Profound cardiogenic shock was defined as refractory hypotension requiring high-dose vasopressor infusion (norepinephrine >0.5 mcg/kg/min) despite adequate intravascular volume replacement. Vitamin D levels were measured as plasma 25(OH)D concentrations and severe vitamin D deficiency was defined as 25(OH)D <10 ng/mL.
A total of 237 subjects (179 men (76%), mean age 56.5 ± 16.5 years) were included in this study. The first monitored rhythm was shockable in 160 subjects (68%). Mean arrest time and CPR times were 25.6 ± 15.7 and 22.8 ± 15.0 min, respectively. Profound cardiogenic shock was observed in 100 subjects (42%). The mean vitamin D level was 12.3 ± 6.7 ng/mL, and vitamin D deficiency was diagnosed in 109 subjects (46%). In profound cardiogenic shock subjects, vitamin D levels were significantly lower (10.7 ± 7.0 vs. 13.4 ± 6.2 ng/mL, P = 0.002) and severe vitamin D deficiency was observed more frequently (63% vs. 34%, P < 0.001). Subjects with profound cardiogenic shock were likely to have longer arrest times (29.5 ± 17.0 vs. 22.7 ± 14.0 min, P = 0.001), left ventricular systolic dysfunction (LVEF < 40%, 73% vs. 38%, P < 0.001), and baseline renal dysfunction (65% vs. 37%, P < 0.001). Multivariate logistic analysis indicated that vitamin D deficiency was significantly associated with profound cardiogenic shock after SCA (OR 2.71, 95% CI 1.42-5.18, P = 0.003) after adjusting for confounding variables.
Severe vitamin D deficiency was strongly associated with profound cardiogenic shock and mortality in patients resuscitated from SCA.
维生素 D 缺乏与多种心血管疾病有关，包括心搏骤停（SCA）。严重的心源性休克与 SCA 患者的发病率和死亡率相关。本研究旨在探讨维生素 D 缺乏与 SCA 患者复苏后严重心源性休克的关系。
我们纳入了因疑似心源性原因导致院外心脏骤停并成功复苏的患者。严重的心源性休克定义为尽管充分补充血容量，但仍需要大剂量升压药输注（去甲肾上腺素>0.5 mcg/kg/min）才能维持血压。通过检测血浆 25（OH）D 浓度来评估维生素 D 水平，严重维生素 D 缺乏定义为 25（OH）D<10ng/mL。
共纳入 237 例患者（男性 179 例（76%），平均年龄 56.5±16.5 岁）。160 例患者（68%）最初监测到的节律为可电击节律。平均停搏时间和心肺复苏时间分别为 25.6±15.7 和 22.8±15.0 分钟。100 例患者（42%）出现严重心源性休克。平均维生素 D 水平为 12.3±6.7ng/mL，109 例患者（46%）诊断为维生素 D 缺乏症。严重心源性休克患者的维生素 D 水平显著较低（10.7±7.0 与 13.4±6.2ng/mL，P=0.002），且严重维生素 D 缺乏症的发生率更高（63%与 34%，P<0.001）。严重心源性休克患者的停搏时间更长（29.5±17.0 与 22.7±14.0 分钟，P=0.001），左心室射血分数（LVEF<40%，73%与 38%，P<0.001）和基础肾功能不全（65%与 37%，P<0.001）更常见。多变量 logistic 分析表明，在校正混杂因素后，维生素 D 缺乏与 SCA 后严重心源性休克（OR 2.71，95%CI 1.42-5.18，P=0.003）显著相关。
严重维生素 D 缺乏与 SCA 患者复苏后严重心源性休克和死亡率密切相关。
