生存影响与并发症：解析维生素D辅助治疗对COVID-19危重症患者的影响——一项多中心队列研究

Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19-A multicenter cohort study.

作者信息

Al Sulaiman Khalid, Korayem Ghazwa B, Aljuhani Ohoud, Altebainawi Ali F, Shawaqfeh Mohammad S, Alarfaj Sumaiah J, Alharbi Reham A, Ageeli Mawaddah M, Alissa Abdulrahman, Vishwakarma Ramesh, Ibrahim Alnada, Alenazi Abeer A, Alghnam Suliman, Alshehri Nadiyah, Alshammari Maqbulah M, Alhubaishi Alaa, Aldhaeefi Mohammed, Alamri Faisal F, Syed Yadullah, Khan Raymond, Alalawi Mai, Alanazi Khalaf A, Alresayes Faisal S, Albarqi Khalid J, Al Ghamdi Ghassan

机构信息

Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

出版信息

Front Med (Lausanne). 2023 Aug 24;10:1237903. doi: 10.3389/fmed.2023.1237903. eCollection 2023.

DOI:10.3389/fmed.2023.1237903

PMID:37692775

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10484515/

Abstract

BACKGROUND

Despite insufficient evidence, vitamin D has been used as adjunctive therapy in critically ill patients with COVID-19. This study evaluates the effectiveness and safety of vitamin D as an adjunctive therapy in critically ill COVID-19 patients.

METHODS

A multicenter retrospective cohort study that included all adult COVID-19 patients admitted to the intensive care units (ICUs) between March 2020 and July 2021. Patients were categorized into two groups based on their vitamin D use throughout their ICU stay (control vs. vitamin D). The primary endpoint was in-hospital mortality. Secondary outcomes were the length of stay (LOS), mechanical ventilation (MV) duration, and ICU-acquired complications. Propensity score (PS) matching (1:1) was used based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analyses were employed as appropriate.

RESULTS

A total of 1,435 patients were included in the study. Vitamin D was initiated in 177 patients (12.3%), whereas 1,258 patients did not receive it. A total of 288 patients were matched (1:1) using PS. The in-hospital mortality showed no difference between patients who received vitamin D and the control group (HR 1.22, 95% CI 0.87-1.71; = 0.26). However, MV duration and ICU LOS were longer in the vitamin D group (beta coefficient 0.24 (95% CI 0.00-0.47), = 0.05 and beta coefficient 0.16 (95% CI -0.01 to 0.33), = 0.07, respectively). As an exploratory outcome, patients who received vitamin D were more likely to develop major bleeding than those who did not [OR 3.48 (95% CI 1.10, 10.94), = 0.03].

CONCLUSION

The use of vitamin D as adjunctive therapy in COVID-19 critically ill patients was not associated with survival benefits but was linked with longer MV duration, ICU LOS, and higher odds of major bleeding.

摘要

背景

尽管证据不足，但维生素D已被用作新型冠状病毒肺炎（COVID-19）重症患者的辅助治疗。本研究评估维生素D作为COVID-19重症患者辅助治疗的有效性和安全性。

方法

一项多中心回顾性队列研究，纳入了2020年3月至2021年7月期间入住重症监护病房（ICU）的所有成年COVID-19患者。根据患者在ICU住院期间维生素D的使用情况将其分为两组（对照组与维生素D组）。主要终点是院内死亡率。次要结局包括住院时间（LOS）、机械通气（MV）时间和ICU获得性并发症。根据预定义标准使用倾向评分（PS）匹配（1:1）。酌情采用多变量逻辑回归、Cox比例风险回归和负二项回归分析。

结果

本研究共纳入1435例患者。177例患者（12.3%）开始使用维生素D，而1258例患者未接受维生素D治疗。共使用PS匹配了288例患者（1:1）。接受维生素D治疗的患者与对照组患者的院内死亡率无差异（风险比1.22，95%置信区间0.87-1.71；P = 0.26）。然而，维生素D组的MV时间和ICU住院时间更长（β系数分别为0.24（95%置信区间0.00-0.47），P = 0.05和β系数0.16（95%置信区间-0.01至0.33），P = 0.07）。作为探索性结局，接受维生素D治疗的患者比未接受维生素D治疗的患者更易发生大出血[比值比3.48（95%置信区间1.10，10.94），P = 0.03]。