Zittermann Armin, Pilz Stefan, Morshuis Michiel, Gummert Jan F, Milting Hendrik
Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.
Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Int J Artif Organs. 2023 Apr;46(4):235-240. doi: 10.1177/03913988231154939. Epub 2023 Mar 9.
Driveline infection is a frequent complication in recipients of durable left ventricular assist devices (LVAD), but its cause is largely unclear. Since vitamin D supplementation can reduce the risk of infections, we aimed at investigating the association of vitamin D deficiency with driveline infection. In 154 patients with continuous flow LVAD implants, we assessed 2-year risk of driveline infection according to vitamin D status (circulating 25-hydroxyvitamin D < 25 nmol/L or ⩾25 nmol/L). Of the study cohort, 34% ( = 53) had 25-hydroxyvitamin D concentrations <25 nmol/L. Kaplan-Meir estimates of 2-year freedom from driveline infection were in the vitamin D deficient and vitamin D non-deficient groups 49.7% and 74.2%, respectively ( = 0.017). Covariate-adjusted hazard ratio of driveline infection for the vitamin D deficient versus non-deficient group was 2.51 [95% CI: 1.11-5.69; = 0.028). Circulating concentrations of endocrine regulators of calcium and phosphorus metabolism such as parathyroid hormone, 1,25-dihydroxyvitamin D, and fibroblast growth factor-23 were not significantly associated with the risk of driveline infection (-values > 0.15). In total, our data indicate that in LVAD recipients deficient vitamin D status is a predictor of driveline infection, but future studies are needed to investigate whether these associations are causal.
驱动线感染是耐用型左心室辅助装置(LVAD)接受者常见的并发症,但其病因尚不清楚。由于补充维生素D可降低感染风险,我们旨在研究维生素D缺乏与驱动线感染之间的关联。在154例接受连续血流LVAD植入的患者中,我们根据维生素D状态(循环25-羟维生素D<25 nmol/L或⩾25 nmol/L)评估了2年的驱动线感染风险。在研究队列中,34%(n = 53)的患者25-羟维生素D浓度<25 nmol/L。维生素D缺乏组和非缺乏组2年无驱动线感染的Kaplan-Meir估计值分别为49.7%和74.2%(P = 0.017)。维生素D缺乏组与非缺乏组驱动线感染的协变量调整风险比为2.51[95%CI:1.11-5.69;P = 0.028]。甲状旁腺激素、1,25-二羟维生素D和成纤维细胞生长因子-23等钙磷代谢内分泌调节因子的循环浓度与驱动线感染风险无显著关联(P值>0.15)。总体而言,我们的数据表明,在LVAD接受者中,维生素D缺乏状态是驱动线感染的一个预测因素,但需要进一步研究来探讨这些关联是否具有因果关系。