Singh Sahib, Sarkar Sauradeep, Gupta Kushagra, Rout Amit
Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA.
Pulmonary Critical Care Medicine, East Carolina University, Greenville, USA.
Cureus. 2022 Apr 30;14(4):e24625. doi: 10.7759/cureus.24625. eCollection 2022 Apr.
Randomized controlled trials (RCTs) have reported conflicting outcomes with the use of vitamin D in critically ill patients. With reporting of newer RCTs, we conducted this updated meta-analysis. Electronic databases were searched for RCTs comparing vitamin D with placebo in critically ill patients admitted to the intensive care unit (ICU). A random-effects meta-analysis was used to calculate the risk ratio (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI). Eleven RCTs with a total of 2,187 patients (vitamin D: n = 1,120; placebo: n = 1,067) were included. Vitamin D when compared to placebo was associated with the decreased duration of mechanical ventilation (SMD = -0.50; 95% CI = [-0.97, -0.03]; p = 0.04) and ICU stay (SMD = -0.60; 95% CI = [-1.03, -0.16]; p = 0.007) without any difference in the mortality (RR = 0.85; 95% CI = [0.68, 1.04]; p = 0.12) and length of hospital stay (SMD = -0.21; 95% CI = (-0.51, 0.09); p = 0.18]. Subgroup analysis showed that parenteral vitamin D may reduce the risk of mortality (RR = 0.54; 95% CI = [0.35, 0.83], p = 0.005). Vitamin D supplementation in critically ill patients decreases the duration of mechanical ventilation and ICU stay. Further studies should identify specific groups of patients who will derive the most benefit from vitamin D supplementation.
随机对照试验（RCT）报告了在危重症患者中使用维生素D的结果相互矛盾。随着更新的RCT报告的出现，我们进行了这项更新的荟萃分析。通过电子数据库搜索在重症监护病房（ICU）住院的危重症患者中比较维生素D与安慰剂的RCT。采用随机效应荟萃分析计算风险比（RR）和标准化均数差（SMD），并给出95%置信区间（CI）。纳入了11项RCT，共2187例患者（维生素D组：n = 1120；安慰剂组：n = 1067）。与安慰剂相比，维生素D与机械通气时间缩短（SMD = -0.50；95%CI = [-0.97, -0.03]；p = 0.04）和ICU住院时间缩短（SMD = -0.60；95%CI = [-1.03, -0.16]；p = 0.007）相关，而死亡率（RR = 0.85；95%CI = [0.68, 1.04]；p = 0.12）和住院时间（SMD = -0.21；95%CI = (-0.51, 0.09)；p = 0.18）无差异。亚组分析表明，肠外补充维生素D可能降低死亡风险（RR = 0.54；95%CI = [0.35, 0.83]，p = 0.005）。对危重症患者补充维生素D可缩短机械通气时间和ICU住院时间。进一步的研究应确定能从补充维生素D中获益最大的特定患者群体。
