极低的维生素 D 水平是严重 COVID-19 住院患者死亡率的一个强有力的独立预测因素。
Very Low Vitamin D Levels are a Strong Independent Predictor of Mortality in Hospitalized Patients with Severe COVID-19.
机构信息
Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
出版信息
Arch Med Res. 2022 Feb;53(2):215-222. doi: 10.1016/j.arcmed.2021.09.006. Epub 2021 Oct 15.
BACKGROUND
There is controversy regarding the association between hypovitaminosis D and COVID-19 outcomes.
AIM OF THE STUDY
We assessed the association between 25-hydroxyvitamin D levels and COVID-19 outcomes in hospitalized subjects with severe SARS-CoV-2 infection.
METHODS
Retrospective cohort study. Serum 25-hydroxyvitamin D levels of subjects with severe COVID-19 pneumonia were measured at hospital admission, between March 17, 2020, and March 1, 2021.
RESULTS
Out of 2,908 patients, 571 (19.6%) had vitamin D deficiency (defined as a serum 25-hydroxyvitamin D level <12.5 ng/mL [<31.25 nmol/L]), and 1069 (36.7%) had levels between 12.5 ng/mL (31.25 nmol/L) and 20 ng/mL 850 nmol/L). Compared to subjects without vitamin D deficiency, those with 25-hydroxyvitamin D level <12.5 ng/mL had higher rates of in-hospital mortality at 30 d (28.0 vs. 17.3%; p <0.001), global mortality (31.9 vs. 20.8%; p <0.001), mechanical ventilation requirement (23.8 vs. 17.2%; p <0.001), and significantly longer hospital stay (median [interquartile range] of 9 [6-17 d] vs. 7 [5-12 d], p <0.001). In the unadjusted analysis, the risk of in-hospital death was greater for patients with vitamin D deficiency (HR 1.43; 95% CI, 1.20-1.70; p <0.001). After adjusting for confounders, the risk of in-hospital death within 30 d remained significantly greater in patients with vitamin D deficiency (HR 1.46; 95% CI, 1.21-1.76; p <0.001). The risk was reduced but remained significant with 25-hydroxyvitamin D levels between 12.5 ng/mL and 20 ng/mL (HR 1.31; 95% CI 1.10-1.55, p = 0.02). In comparison with other clinical biomarkers, vitamin D deficiency was an independent predictive marker of in-hospital mortality after adjusting for confounders.
CONCLUSION
Very low 25-hydroxyvitamin D levels measured at hospital admission were significantly associated with in-hospital mortality and are a useful prognostic biomarker in severe COVID-19 patients.
背景
维生素 D 缺乏与 COVID-19 结局之间的关联存在争议。
目的
我们评估了血清 25-羟维生素 D 水平与严重 SARS-CoV-2 感染住院患者 COVID-19 结局之间的关系。
方法
回顾性队列研究。2020 年 3 月 17 日至 2021 年 3 月 1 日期间，测量了患有严重 COVID-19 肺炎的患者入院时的血清 25-羟维生素 D 水平。
结果
在 2908 名患者中，571 名（19.6%）存在维生素 D 缺乏症（定义为血清 25-羟维生素 D 水平<12.5ng/mL [<31.25nmol/L]），1069 名（36.7%）的水平在 12.5ng/mL（31.25nmol/L）至 20ng/mL（850nmol/L）之间。与无维生素 D 缺乏症的患者相比，血清 25-羟维生素 D 水平<12.5ng/mL 的患者在 30 天住院死亡率（28.0% vs. 17.3%；p<0.001）、全球死亡率（31.9% vs. 20.8%；p<0.001）、机械通气需求（23.8% vs. 17.2%；p<0.001）以及显著延长的住院时间（中位数[四分位距]为 9[6-17 d] vs. 7[5-12 d]；p<0.001）更高。在未调整分析中，维生素 D 缺乏症患者住院死亡的风险更高（HR 1.43；95%CI，1.20-1.70；p<0.001）。在调整混杂因素后，维生素 D 缺乏症患者 30 天内住院死亡的风险仍然显著更高（HR 1.46；95%CI，1.21-1.76；p<0.001）。当血清 25-羟维生素 D 水平在 12.5ng/mL 和 20ng/mL 之间时，风险虽然降低但仍具有统计学意义（HR 1.31；95%CI，1.10-1.55，p=0.02）。与其他临床生物标志物相比，维生素 D 缺乏症是调整混杂因素后住院死亡率的独立预测标志物。
结论
入院时测量的极低血清 25-羟维生素 D 水平与住院死亡率显著相关，是严重 COVID-19 患者有用的预后生物标志物。
Zotero 插件