Chouët Justine, Sacco Guillaume, Karras Spyridon N, Llewellyn David J, Sánchez-Rodríguez Dolores, Annweiler Cédric
Department of Geriatric Medicine, Cholet Hospital, Cholet, France.
Department of Geriatric Medicine, Angers University Memory Clinic, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France.
Front Neurol. 2020 Sep 18;11:1034. doi: 10.3389/fneur.2020.01034. eCollection 2020.
Vitamin D is involved in brain health and function. Our objective was to determine whether the serum 25-hydroxyvitamin D (25OHD) concentration was associated with delirium in a case-control study of geriatric inpatients. Sixty cases with delirium (mean ± SD, 84.8 ± 5.7years; 58.3% female) and 180 age- and gender-matched controls were enrolled in a geriatric acute care unit between 2012 and 2014. The diagnosis of delirium was made using the Confusion Assessment Method. Hypovitaminosis D was defined using consecutively the consensual threshold value of 50 nmol/L and a threshold value calculated from a sensitivity-specificity analysis. Age, gender, number of acute diseases, use of psychoactive drugs, season of testing, and serum concentrations of calcium, parathyroid hormone, creatinine, albumin, TSH, vitamin B9 and vitamin B12 were used as potential confounders. The 60 cases with delirium exhibited lower 25OHD concentration than 180 matched controls (35.4 ± 30.0 nmol/L vs. 45.9 ± 34.5 nmol/L, = 0.035). Increased 25OHD concentration was associated with a decrease in delirium prevalence (OR = 0.99 [95CI: 0.98-0.99] per nmol/L of 25OHD, = 0.038). The concentration distinguishing between cases and controls with the best sensitivity-specificity was found between 29.5 and 30.5 nmol/L. The regression models showed that delirium was associated with hypovitaminosis D defined either as 25OHD ≤ 50 nmol/L (OR = 2.37 [95CI: 1.07-5.25], = 0.034) or as 25OHD ≤ 30 nmol/L (OR = 2.66 [95 CI: 1.30-5.45], = 0.008). Decreased serum 25OHD concentrations were associated with delirium among acute geriatric inpatients. The threshold concentration to differentiate between cases and controls was around 30 nmol/L.
维生素D与大脑健康和功能有关。我们的目标是在一项老年住院患者的病例对照研究中，确定血清25-羟基维生素D（25OHD）浓度是否与谵妄有关。2012年至2014年期间，在一家老年急性护理病房纳入了60例谵妄患者（平均±标准差，84.8±5.7岁；58.3%为女性）和180例年龄和性别匹配的对照。谵妄的诊断采用意识模糊评估法。维生素D缺乏症的定义依次采用50 nmol/L的共识阈值和通过敏感性-特异性分析计算出的阈值。年龄、性别、急性疾病数量、精神活性药物的使用、检测季节以及血清钙、甲状旁腺激素、肌酐、白蛋白、促甲状腺激素、维生素B9和维生素B12的浓度被用作潜在的混杂因素。60例谵妄患者的25OHD浓度低于180例匹配对照（35.4±30.0 nmol/L对45.9±34.5 nmol/L, P = 0.035）。25OHD浓度升高与谵妄患病率降低相关（每nmol/L 25OHD的比值比=0.99 [95%置信区间：0.98 - 0.99]，P = 0.038）。在29.5至30.5 nmol/L之间发现了区分病例和对照的具有最佳敏感性-特异性的浓度。回归模型显示，谵妄与定义为25OHD≤50 nmol/L（比值比=2.37 [95%置信区间：1.07 - 5.25]，P = 0.034）或25OHD≤30 nmol/L（比值比=2.66 [95%置信区间：1.30 - 5.45]，P = 0.008）的维生素D缺乏症相关。老年急性住院患者中血清25OHD浓度降低与谵妄有关。区分病例和对照的阈值浓度约为30 nmol/L。
