急诊入院时维生素D缺乏是接受早期方案驱动的复苏集束治疗的感染性休克患者的死亡预测因素。

Vitamin D deficiency on admission to the emergency department is a mortality predictor for patients with septic shock treated with early protocol-driven resuscitation bundle therapy.

作者信息

Chae Bora, Kim Youn-Jung, Kim Sang Min, Hong Seok-In, Shin Yo Sep, Kim June-Sung, Ryoo Seung Mok, Kim Won Young

机构信息

Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

出版信息

Am J Med Sci. 2023 Apr;365(4):361-367. doi: 10.1016/j.amjms.2022.10.005. Epub 2022 Oct 18.

DOI:10.1016/j.amjms.2022.10.005

PMID:36265656

Abstract

BACKGROUND

Vitamin D is an important immune modulator and is associated with susceptibility to infection. However, past studies have reported inconsistent results regarding the association between vitamin D deficiency and mortality in patients with sepsis, and early-stage data regarding septic shock are limited. This study aimed to determine the relationship between vitamin D deficiency on admission to the emergency department (ED) and mortality in patients with septic shock.

METHODS

We analyzed prospectively collected data on adult patients with septic shock who were treated with protocol-driven resuscitation bundle therapy in the ED between September 2019 and February 2021. Septic shock was defined by the sepsis-3 definition and vitamin D deficiency was defined as a 25-hydroxyvitamin D <20 ng/ml. The primary outcome was 30-day mortality.

RESULTS

A total of 302 patients were included, 236 (78.1%) patients had vitamin D deficiency; it was significantly higher in non-survivors than in survivors (89.3% vs. 73.9%, P = 0.004). Mortality was higher in vitamin D deficient patients than in non-deficient patients (31.8% vs. 13.6%, P = 0.004). In multivariate analysis, vitamin D deficiency (odds ratio [OR], 2.43; 95 % confidence interval [CI], 1.03-5.74), hyperlactatemia (OR, 3.65; 95 % CI, 1.95-6.83), Sequential Organ Failure Assessment scores (OR, 1.22; 95% CI, 1.09-1.36), and albumin levels (OR, 0.39; 95% CI, 0.21-0.73) were significantly associated with 30-day mortality.

CONCLUSIONS

Vitamin D deficiency was prevalent in patients with septic shock visiting the ED and was associated with mortality.

摘要

背景

维生素D是一种重要的免疫调节剂，与感染易感性相关。然而，既往研究报道维生素D缺乏与脓毒症患者死亡率之间的关联结果并不一致，且关于感染性休克的早期数据有限。本研究旨在确定急诊科（ED）收治时维生素D缺乏与感染性休克患者死亡率之间的关系。

方法

我们分析了2019年9月至2021年2月期间在急诊科接受方案驱动的复苏集束治疗的成年感染性休克患者的前瞻性收集数据。感染性休克根据脓毒症-3定义确定，维生素D缺乏定义为25-羟基维生素D<20 ng/ml。主要结局为30天死亡率。

结果

共纳入302例患者，236例（78.1%）患者存在维生素D缺乏；非幸存者中的维生素D缺乏率显著高于幸存者（89.3%对73.9%，P = 0.004）。维生素D缺乏患者的死亡率高于非缺乏患者（31.8%对13.6%，P = 0.004）。多因素分析显示，维生素D缺乏（比值比[OR]，2.43；95%置信区间[CI]，1.03 - 5.74）、高乳酸血症（OR，3.65；95% CI，1.95 - 6.83）、序贯器官衰竭评估评分（OR，1.22；95% CI，1.09 - 1.36）和白蛋白水平（OR，0.39；95% CI，0.21 - 0.73）与30天死亡率显著相关。