University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.
Laboratory of Biochemistry, Rabta Hospital, Tunis, Tunisia.
Biol Res Nurs. 2020 Jul;22(3):388-396. doi: 10.1177/1099800420923746. Epub 2020 May 12.
Patients in intensive care units (ICUs) are at high risk of unfavorable outcomes. Considering the role of vitamin D (Vit D) in cardiovascular and immune functions, Vit D deficiency could affect ICU patients' outcomes. This study aimed to evaluate Vit D status and its predictive value for outcome in ICU patients.
A total of 169 ICU patients were followed during ICU stay. Primary outcome was the occurrence of at least one major adverse event; secondary outcomes were organ failure, septic shock, ICU-acquired infection, other adverse events, and ICU mortality. Plasma 25-hydroxyvitamin D (25(OH)D) was assessed by immunoassay. Multivariate Cox regression analyses were performed to test the associations of low 25(OH)D levels with poor outcomes.
Around 75% of patients had 25(OH)D levels <12 ng/ml. During their ICU stay, 114 patients experienced a major adverse event, 85 patients presented an ICU-acquired infection, and 22 patients died. Plasma 25(OH)D levels <12 ng/ml were associated with higher risk of major adverse events, Hazard ratio [95% CI], 4.47 [1.77, 11.3], = .020, and ICU-acquired infection, 2.67 [1.01, 7.42], = .049, but not with increased risk of ICU mortality.
Hypovitaminosis D is very common in ICU patients. Results of the present study show that low plasma 25(OH)D levels are associated with increased risk of unfavorable outcomes in these patients. Additional research is needed to investigate the impact of Vit D status and effect of Vit D supplementation in ICU patients.
重症监护病房（ICU）的患者存在不良结局的高风险。考虑到维生素 D（Vit D）在心血管和免疫功能中的作用，Vit D 缺乏可能会影响 ICU 患者的结局。本研究旨在评估 ICU 患者的 Vit D 状态及其对结局的预测价值。
共对 169 例 ICU 患者进行了 ICU 期间的随访。主要结局是发生至少 1 项主要不良事件；次要结局是器官衰竭、感染性休克、ICU 获得性感染、其他不良事件和 ICU 死亡率。通过免疫测定法评估血浆 25-羟维生素 D（25(OH)D）水平。采用多变量 Cox 回归分析来检验低 25(OH)D 水平与不良结局的相关性。
约 75%的患者 25(OH)D 水平<12ng/ml。在 ICU 期间，114 例患者发生了主要不良事件，85 例患者出现了 ICU 获得性感染，22 例患者死亡。血浆 25(OH)D 水平<12ng/ml 与主要不良事件风险增加相关，风险比[95%CI]为 4.47[1.77，11.3]，P=0.020，与 ICU 获得性感染风险增加相关，风险比为 2.67[1.01，7.42]，P=0.049，但与 ICU 死亡率增加无关。
维生素 D 缺乏在 ICU 患者中非常常见。本研究结果表明，低血浆 25(OH)D 水平与这些患者不良结局风险增加相关。需要进一步研究来探讨 Vit D 状态的影响和 Vit D 补充对 ICU 患者的作用。
