危重症患者血液中 25-羟维生素 D 异常：患病率、预测因素及其与住院死亡率的关系。

Abnormal blood 25-hydroxyvitamin D in critically ill patients: prevalence, predictors, and its association with in-hospital mortality.

机构信息

Intensive Care Unit, The First People's Hospital of Chenzhou, Chenzhou, 423000, Hunan, China.

Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.

出版信息

Eur J Med Res. 2022 Jul 6;27(1):111. doi: 10.1186/s40001-022-00736-6.

DOI:10.1186/s40001-022-00736-6

PMID:35794582

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9257555/

Abstract

BACKGROUND

Abnormal vitamin D is prevalent in critical care settings, but its association with prognosis remains unclear. The study aimed to investigate the prevalence and predictors of abnormal blood 25-hydroxyvitamin D (25(OH)D), as well as its association with prognosis in critically ill patients.

METHODS

Patients aged ≥ 18 years who were once admitted to the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center between 2008 and 2019 with at least one measurement record of blood 25(OH)D were included as study population. Baseline characteristics associated with deficient or elevated blood 25(OH)D were investigated by univariable logistic regression analysis. The association between abnormal blood 25(OH)D and hospital mortality was examined by multivariable logistic regression analysis.

RESULTS

A total of 1091 patients were included. Deficient 25(OH)D (< 30 ng/mL) was found in 790 (72.41%) patients and 17 (1.56%) were with an elevated level (> 60 ng/mL). A younger age, male, comorbid liver disease, and dialysis were risk factors of deficient blood 25(OH)D, while comorbid myocardial infarction, dementia, and rheumatic disease were protective factors evaluated by univariable logistic regression. Being admitted to cardiac vascular ICU or coronary care unit were associated with increased risk of elevated blood 25(OH)D. Patients with elevated blood 25(OH)D showed non-significantly higher hospital mortality compared to those with normal or deficient blood 25(OH)D (35.29% versus 14.44% and 14.56%, P = 0.058). After adjusted for potential confounding factors, elevated blood 25(OH)D was associated with increased risk of hospital mortality [odds ratio (OR) 3.80, 95% confidence interval (CI) 1.22-11.82, P = 0.021] when compared to those with normal blood 25(OH)D, but there was no significant association between deficient blood 25(OH)D and hospital mortality (OR 1.12, 95% CI 0.74-1.72, P = 0.589).

CONCLUSIONS

These findings suggest deficient blood 25(OH)D was rather common in critically ill patients, but was not an independent risk factor of hospital mortality, while elevated blood 25(OH)D was associated with worse prognosis.

摘要

背景

危重病患者普遍存在维生素 D 异常，但与预后的关系尚不清楚。本研究旨在调查重症患者中血液 25-羟维生素 D（25(OH)D）异常的发生率和预测因素，以及其与预后的关系。

方法

本研究纳入了 2008 年至 2019 年间曾入住 Beth Israel Deaconess Medical Center 重症监护病房（ICU）且至少有一次血液 25(OH)D 测量记录的年龄≥18 岁的患者作为研究对象。采用单变量逻辑回归分析探讨与血液 25(OH)D 缺乏或升高相关的基线特征。采用多变量逻辑回归分析探讨异常血液 25(OH)D 与住院死亡率的关系。

结果

共纳入 1091 例患者。790 例（72.41%）患者存在 25(OH)D 缺乏（<30ng/mL），17 例（1.56%）患者存在 25(OH)D 升高（>60ng/mL）。年龄较小、男性、合并肝脏疾病和透析是血液 25(OH)D 缺乏的危险因素，而合并心肌梗死、痴呆和风湿性疾病是血液 25(OH)D 缺乏的保护因素。被收入心血管 ICU 或冠心病监护病房与血液 25(OH)D 升高的风险增加相关。与血液 25(OH)D 正常或缺乏的患者相比，血液 25(OH)D 升高的患者的住院死亡率非显著升高（35.29%比 14.44%和 14.56%，P=0.058）。在校正了潜在混杂因素后，与血液 25(OH)D 正常的患者相比，血液 25(OH)D 升高的患者的住院死亡率更高[比值比（OR）3.80，95%置信区间（CI）1.22-11.82，P=0.021]，但血液 25(OH)D 缺乏与住院死亡率之间无显著相关性（OR 1.12，95%CI 0.74-1.72，P=0.589）。