重症监护病房 COVID-19 患者低循环维生素 D 作为不良结局的预测因子。
Low Circulating Vitamin D in Intensive Care Unit-Admitted COVID-19 Patients as a Predictor of Negative Outcomes.
机构信息
Intensive Care Unit, Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia, Moscow, Russia.
Anesthesiology and Intensive Care Unit, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
出版信息
J Nutr. 2021 Aug 7;151(8):2199-2205. doi: 10.1093/jn/nxab107.
BACKGROUND
Vitamin D deficiency has been associated with an increased risk of respiratory infections.
OBJECTIVES
The study aimed to evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in patients admitted to the intensive care unit (ICU) as a predictor of coronavirus disease 2019 (COVID-19) mortality.
METHODS
A single-center retrospective observational study was conducted. Forty adult patients (50% men) with confirmed COVID-19 who were admitted to the ICU were enrolled. The primary endpoint was mortality at day 60. Serum 25(OH)D concentration was measured on the day of admission to the ICU. We used the Mann-Whitney test, Fisher's exact test, Kaplan-Meier analysis, and receiver operator characteristic (ROC) analysis to assess serum 25(OH)D concentration as a predictor of COVID-19 mortality.
RESULTS
All 40 patients had a low median (IQR) serum 25(OH)D concentration at admission [12 (9-15) ng/mL]. The median (IQR) serum 25(OH)D concentration was greater in survivors [13.3 (10.0-17.1) ng/mL, n = 22] than in nonsurvivors [9.6 (7.9-14.2) ng/mL; n = 18], P = 0.044. The area under the ROC curve was 0.69 (95% CI: 0.52, 0.86; P = 0.044). The 60-d mortality rate of those with serum 25(OH)D concentrations ≤9.9 ng/mL (n = 14, 71%) tended to be greater than that of those with concentrations >9.9 ng/mL (n = 26, 31%) (P = 0.065), and they had a 5.6-fold higher risk of death (OR: 5.63; 95% CI: 1.35, 23.45; P = 0.018).
CONCLUSIONS
The ICU patients had a low serum 25(OH)D concentration. Serum 25(OH)D concentrations ≤9.9 ng/mL on admission can be used to predict in-hospital mortality in patients with COVID-19.This trial was registered at clinicaltrials.gov as NCT04450017.
背景
维生素 D 缺乏与呼吸道感染风险增加有关。
目的
本研究旨在评估重症监护病房（ICU）入院患者的血清 25-羟维生素 D [25(OH)D]浓度，以预测 2019 年冠状病毒病（COVID-19）的死亡率。
方法
进行了一项单中心回顾性观察性研究。纳入了 40 名确诊为 COVID-19 且入住 ICU 的成年患者（50%为男性）。主要终点为第 60 天的死亡率。在 ICU 入院当天测量血清 25(OH)D 浓度。我们使用 Mann-Whitney 检验、Fisher 确切检验、Kaplan-Meier 分析和受试者工作特征（ROC）分析来评估血清 25(OH)D 浓度作为 COVID-19 死亡率的预测指标。
结果
所有 40 名患者的血清 25(OH)D 浓度中位数（IQR）均较低[12（9-15）ng/mL]。幸存者的血清 25(OH)D 浓度中位数（IQR）大于非幸存者[13.3（10.0-17.1）ng/mL，n=22 与 9.6（7.9-14.2）ng/mL；n=18，P=0.044]。ROC 曲线下面积为 0.69（95%CI：0.52，0.86；P=0.044）。血清 25(OH)D 浓度≤9.9ng/mL（n=14，71%）的 60 天死亡率趋势大于浓度>9.9ng/mL（n=26，31%）（P=0.065），且死亡风险增加 5.6 倍（OR：5.63；95%CI：1.35，23.45；P=0.018）。
结论
ICU 患者的血清 25(OH)D 浓度较低。入院时血清 25(OH)D 浓度≤9.9ng/mL 可用于预测 COVID-19 患者的住院死亡率。本试验在 clinicaltrials.gov 上注册为 NCT04450017。
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