Epidemiology & Public Health Group, University of Exeter, Exeter, UK.
UConn Center on Aging, University of Connecticut, Farmington, Connecticut, USA.
J Am Geriatr Soc. 2021 Feb;69(2):365-372. doi: 10.1111/jgs.16853. Epub 2020 Oct 5.
BACKGROUND/OBJECTIVES: Delirium is common in older adults, especially following hospitalization. Because low vitamin D levels may be associated with increased delirium risk, we aimed to determine the prognostic value of blood vitamin D levels, extending our previous genetic analyses of this relationship.
Prospective cohort analysis.
Community-based cohort study of adults from 22 cities across the United Kingdom (the UK Biobank).
Adults aged 60 and older by the end of follow-up in the linked hospital inpatient admissions data, up to 14 years after baseline (n = 351,320).
At baseline, serum vitamin D (25-OH-D) levels were measured. We used time-to-event models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between vitamin D deficiency and incident hospital-diagnosed delirium, adjusted for age, sex, assessment month, assessment center, and ethnicity. We performed Mendelian randomization genetic analysis in European participants to further investigate vitamin D and delirium risk.
A total of 3,634 (1.03%) participants had at least one incident hospital-diagnosed delirium episode. Vitamin D deficiency (<25 nmol/L) predicted a large incidence in delirium (HR = 2.49; 95% CI = 2.24-2.76; P = 310 , compared with >50 nmol/L). Increased risk was not limited to the deficient group: insufficient levels (25-50 nmol/L) were also at increased risk (HR = 1.38; 95% CI = 1.28-1.49; P = 410 ). The association was independent of calcium levels, hospital-diagnosed fractures, dementia, and other relevant cofactors. In genetic analysis, participants carrying more vitamin D-increasing variants had a reduced likelihood of incident delirium diagnosis (HR = .80 per standard deviation increase in genetically instrumented vitamin D: .73-.87; P = 2*10 ).
Progressively lower vitamin D levels predicted increased risks of incident hospital-diagnosed delirium, and genetic evidence supports a shared causal pathway. Because low vitamin D levels are simple to detect and inexpensive and safe to correct, an intervention trial to confirm these results is urgently needed.
背景/目的：谵妄在老年人中很常见，尤其是在住院后。由于维生素 D 水平低可能与谵妄风险增加有关，我们旨在确定血液维生素 D 水平的预后价值，扩展我们之前对这种关系的遗传分析。
前瞻性队列分析。
英国 22 个城市的社区为基础的成年人队列研究（英国生物库）。
在链接的医院住院患者数据中，截止到随访结束时年龄在 60 岁及以上的成年人，最长可达基线后 14 年（n = 351320）。
在基线时测量血清维生素 D（25-OH-D）水平。我们使用时间事件模型来估计维生素 D 缺乏与新发医院诊断的谵妄之间的风险比（HR）和 95%置信区间（CI），并调整年龄、性别、评估月份、评估中心和种族。我们在欧洲参与者中进行孟德尔随机遗传分析，以进一步研究维生素 D 和谵妄风险之间的关系。
共有 3634 名（1.03%）参与者至少有一次新发的医院诊断的谵妄发作。维生素 D 缺乏症（<25 nmol/L）预测谵妄的发病率很高（HR = 2.49；95%CI = 2.24-2.76；P = 310 -16 ，与>50 nmol/L 相比）。风险增加不仅限于缺乏组：不足水平（25-50 nmol/L）也处于增加的风险中（HR = 1.38；95%CI = 1.28-1.49；P = 410 -16 ）。这种关联与钙水平、医院诊断的骨折、痴呆和其他相关的混杂因素无关。在遗传分析中，携带更多增加维生素 D 的变异的参与者发生新发谵妄诊断的可能性降低（HR = 0.80 每标准偏差增加遗传上确定的维生素 D：0.73-0.87；P = 2*10 -10 ）。
维生素 D 水平逐渐降低预测了新发医院诊断的谵妄风险的增加，遗传证据支持共同的因果途径。由于低维生素 D 水平很容易检测，并且纠正既便宜又安全，因此迫切需要进行一项干预试验来证实这些结果。
