Thiele Kirsten, Cornelissen Anne, Florescu Roberta, Kneizeh Kinan, Brandenburg Vincent Matthias, Witte Klaus, Marx Nikolaus, Schuh Alexander, Stöhr Robert
Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany.
Department of Cardiology and Nephrology, Rhein-Maas Klinikum, 52146 Wuerselen, Germany.
J Clin Med. 2022 May 12;11(10):2733. doi: 10.3390/jcm11102733.
Background: Deficiency in vitamin D3 and its metabolites has been linked to dismal outcomes in patients with chronic diseases, including cardiovascular disease and heart failure (HF). It remains unclear if a vitamin D3 status is a prognostic feature in patients with acute decompensated HF. Methods: We assessed serum levels of 25-OH-vitamin D3 and 1,25-(OH)2-vitamin D3 in 139 patients with acute HF who had been admitted to the intermediate care unit of a maximum care hospital. The follow-up period was one year. After exclusion of patients with sampling errors and those who were lost to follow-up, 118 patients remained in the final study cohort. Outcome estimates by 25-OH-vitamin D3 and 1,25-(OH)2-vitamin D3 levels were compared to the Seattle Heart Failure (SHF) Model. Results: More than two-thirds (79.7%) of the patients showed inadequate 25-OH-vitamin D3 levels (i.e., <30 ng/mL) upon admission. Low levels of 1,25-(OH)2-vitamin D3 (i.e., <19.9 pg/mL) were observed in 16.1% of patients. Of the 118 HF patients, 22 (19%) died during the following 12 months. There were no differences in vitamin D3 levels between patients who died and those who survived, neither in 25-OH-vitamin D3 (23.37 ± 19.14 ng/mL vs. 19.11 ± 12.25 ng/mL; p = 0.19) nor in 1,25-(OH)2-vitamin D3 levels (31.10 ± 19.75 ng/mL vs. 38.25 ± 15.73 ng/mL; p = 0.02); therefore, vitamin D3 levels alone did not predict one-year survival (AUC [25-OH-vitamin D3] 0.50; 95% CI 0.34−0.65; AUC [1,25-(OH)2-vitamin D3] 0.62; 95% CI 0.48−0.76). Moreover, whilst the SHF model exhibited acceptable discriminatory ability for predicting one-year mortality (AUC 0.79; 95% CI 0.66−0.91), adding vitamin D levels on admission to the SHF score did not improve its discriminatory value. Conclusion: Our data do not support the use of vitamin D3 screening in patients admitted with acute decompensated HF to aid prognostication.
维生素D3及其代谢产物缺乏与包括心血管疾病和心力衰竭（HF）在内的慢性病患者的不良预后有关。急性失代偿性HF患者的维生素D3状态是否为预后特征仍不清楚。方法：我们评估了139例入住一家大型医院中级护理病房的急性HF患者的血清25-羟基维生素D3和1,25-二羟基维生素D3水平。随访期为一年。排除有采样误差的患者和失访患者后，最终研究队列中有118例患者。将25-羟基维生素D3和1,25-二羟基维生素D3水平的预后估计值与西雅图心力衰竭（SHF）模型进行比较。结果：超过三分之二（79.7%）的患者入院时25-羟基维生素D3水平不足（即<30 ng/mL）。16.1%的患者观察到1,25-二羟基维生素D3水平低（即<19.9 pg/mL）。在118例HF患者中，22例（19%）在接下来的12个月内死亡。死亡患者和存活患者的维生素D3水平没有差异，25-羟基维生素D3水平（23.37±19.14 ng/mL对19.11±12.25 ng/mL；p = 0.19）和1,25-二羟基维生素D3水平（31.10±19.75 ng/mL对38.25±15.73 ng/mL；p = 0.02）均无差异；因此，仅维生素D3水平不能预测一年生存率（AUC [25-羟基维生素D3] 0.50；95% CI 0.34−0.65；AUC [1,25-二羟基维生素D3] 0.62；95% CI 0.48−0.76）。此外，虽然SHF模型在预测一年死亡率方面表现出可接受的辨别能力（AUC 0.79；95% CI 0.66−0.91），但将入院时的维生素D水平添加到SHF评分中并没有提高其辨别价值。结论：我们的数据不支持对急性失代偿性HF入院患者进行维生素D3筛查以辅助预后评估。
