Zhang Yulin, Li Jiawen, Qiu Yu, Gong Xue, He Yunru, Yue Peng, Zheng Xiaolan, Liu Lei, Liao Hongyu, Zhou Kaiyu, Hua Yimin, Li Yifei
Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Front Cardiovasc Med. 2021 Nov 15;8:734504. doi: 10.3389/fcvm.2021.734504. eCollection 2021.
Vitamin D (VitD) is an important pleiotropic hormone for organ systems. Studies have focused on the level of VitD, especially that of 25-hydroxyvitamin D (25-(OH)-VitD), in patients after cardiac surgery and the relationship between VitD deficiency and adverse outcomes, but the results have been inconsistent. We carried out a meta-analysis to evaluate differences in the 25-(OH)-VitD level before and after cardiac surgery, and evaluated the predictive value of 25-(OH)-VitD level in the clinical outcomes of patients undergoing cardiac surgery. Studies related to VitD level and cardiac surgery were searched from PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases from inception to October 2020. We applied the Newcastle-Ottawa Scale to assess the risk of a bias in individual studies. We examined the heterogeneity and publication bias and performed subgroup analyses and sensitivity analyses. Fifteen studies were included in our analysis. The 25-(OH)-VitD level was significantly lower immediately after surgery [stand mean difference (SMD), 0.69; 95%CI (0.1, 1.28), = 0.023] and 24-h after surgery [0.84; (0.47, 1.21), 0.000] compared with that before surgery. A higher prevalence of 25-(OH)-VitD deficiency was recorded 24 h after surgery [RR, 0.59; 95%CI (0.47, 0.73), = 0.00]. Pooled results demonstrated a significant relationship between the preoperative 25-(OH)-VitD level and vasoactive-inotropic score (VIS) [SMD, -3.71; 95%CI (-6.32, -1.10); = 0.005], and patients with 25-(OH)-VitD deficiency revealed a comparatively poor prognosis and severe condition after cardiac surgery [-0.80; (-1.41, -0.19), 0.01]. However, 25-(OH)-VitD deficiency was not associated with the duration of stay in the intensive care unit. Cardiac surgery would leads to deficiency of 25-(OH)-VitD. And the preoperative and postoperative levels of 25-(OH)-VitD are associated with adverse events, which is eligible to work as an indicator to demonstrate clinical outcomes.
维生素D（VitD）是一种对多个器官系统都很重要的多效性激素。研究聚焦于心脏手术后患者的VitD水平，尤其是25-羟基维生素D（25-(OH)-VitD）水平，以及VitD缺乏与不良预后之间的关系，但结果并不一致。我们进行了一项荟萃分析，以评估心脏手术前后25-(OH)-VitD水平的差异，并评估25-(OH)-VitD水平对心脏手术患者临床结局的预测价值。从PubMed、EMBASE、科学网和考克兰系统评价数据库中检索了从建库至2020年10月与VitD水平和心脏手术相关的研究。我们应用纽卡斯尔-渥太华量表评估单个研究的偏倚风险。我们检查了异质性和发表偏倚，并进行了亚组分析和敏感性分析。我们的分析纳入了15项研究。与术前相比，术后即刻[标准化均数差（SMD），0.69；95%置信区间（CI）（0.1，1.28），P = 0.023]和术后24小时[0.84；（0.47，1.21），P = 0.000]的25-(OH)-VitD水平显著降低。术后24小时记录到25-(OH)-VitD缺乏的患病率更高[相对危险度（RR），0.59；95%CI（0.47，0.73），P = 0.00]。汇总结果显示术前25-(OH)-VitD水平与血管活性药物-正性肌力药物评分（VIS）之间存在显著关系[SMD，-3.71；95%CI（-6.32，-1.10）；P = 0.005]，且25-(OH)-VitD缺乏的患者心脏手术后预后相对较差且病情较重[-0.80；（-1.41，-0.19），P = 0.01]。然而，25-(OH)-VitD缺乏与重症监护病房住院时间无关。心脏手术会导致25-(OH)-VitD缺乏。并且术前和术后的25-(OH)-VitD水平与不良事件相关，有资格作为反映临床结局的指标。
