Department of Endocrinology and Metabolism, Innovation Center for Wound Repair, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China.
Chinese Cochrane Center, Chinese EBM Center, West China Hospital, Sichuan University, Chengdu, China.
J Diabetes Investig. 2023 Jan;14(1):122-131. doi: 10.1111/jdi.13917. Epub 2022 Oct 6.
AIMS/INTRODUCTION: The aim of this study was to examine the correlation between serum vitamin D concentrations and prognosis among Chinese individuals with diabetic foot ulcers (DFUs).
We retrospectively recruited 488 adults with DFUs in West China Hospital from 1 January 2012 to 31 December 2019. After telephone follow up, 275 patients were finally included. We compared serum vitamin D concentrations among DFUs patients with different prognostic status, and examined the association of vitamin D status with prognostic variables by Kaplan-Meier analysis. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for all-cause mortality.
The median concentration of serum vitamin D of patients with DFUs was 37.78 nmol/L (interquartile range 27.91-50.66 nmol/L), with 31.6% having vitamin D deficiency (<30 nmol/L) and 42.2% having insufficient vitamin D (<50 nmol/L). During a median follow-up period of 52 months, 65 patients died, with an all-cause mortality of 23.64%. Vitamin D deficiency was independently linked to increased all-cause mortality after multivariable adjustments (hazard ratio 0.565, 95% confidence interval 0.338-0.946, P = 0.030). There were no significant differences between vitamin D concentrations and other outcomes of DFUs. Patients who suffered amputations had a tendency of lower vitamin D concentrations (34.00 [interquartile range 26.90-41.81] vs 40.21 [interquartile range 29.60-53.96] nmol/L, P = 0.053).
Vitamin D deficiency was significantly associated with increased all-cause mortality in Chinese individuals with DFUs. Vitamin D supplementation might be a potential therapy for DFUs to prevent premature death and improve outcomes.
目的/引言：本研究旨在探讨血清维生素 D 浓度与中国糖尿病足溃疡（DFU）患者预后之间的相关性。
我们回顾性招募了 2012 年 1 月 1 日至 2019 年 12 月 31 日期间在华西医院就诊的 488 例 DFU 成年患者。通过电话随访，最终纳入 275 例患者。我们比较了不同预后状态的 DFU 患者的血清维生素 D 浓度，并通过 Kaplan-Meier 分析检查了维生素 D 状态与预后变量的关系。Cox 比例风险模型用于估计所有原因死亡率的风险比和 95%置信区间。
DFU 患者血清维生素 D 浓度中位数为 37.78 nmol/L（四分位距 27.91-50.66 nmol/L），其中 31.6%存在维生素 D 缺乏症（<30 nmol/L），42.2%存在维生素 D 不足症（<50 nmol/L）。在中位随访 52 个月期间，有 65 例患者死亡，总死亡率为 23.64%。多变量调整后，维生素 D 缺乏与全因死亡率增加独立相关（风险比 0.565，95%置信区间 0.338-0.946，P=0.030）。维生素 D 浓度与 DFU 的其他结局之间无显著差异。截肢患者的维生素 D 浓度有降低的趋势（34.00 [四分位距 26.90-41.81] vs 40.21 [四分位距 29.60-53.96] nmol/L，P=0.053）。
维生素 D 缺乏与中国 DFU 患者的全因死亡率显著相关。维生素 D 补充可能是预防 DFU 患者过早死亡和改善结局的一种潜在治疗方法。
