Cutuli Salvatore Lucio, Ferrando Elena Sancho, Cammarota Fabiola, Franchini Emanuele, Caroli Alessandro, Lombardi Gianmarco, Tanzarella Eloisa Sofia, Grieco Domenico Luca, Antonelli Massimo, De Pascale Gennaro
Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
J Anesth Analg Crit Care. 2024 Jan 23;4(1):4. doi: 10.1186/s44158-024-00139-5.
Severe infections frequently require admission to the intensive care unit and cause life-threatening complications in critically ill patients. In this setting, severe infections are acknowledged as prerequisites for the development of sepsis, whose pathophysiology implies a dysregulated host response to pathogens, leading to disability and mortality worldwide.Vitamin D is a secosteroid hormone that plays a pivotal role to maintain immune system homeostasis, which is of paramount importance to resolve infection and modulate the burden of sepsis. Specifically, vitamin D deficiency has been widely reported in critically ill patients and represents a risk factor for the development of severe infections, sepsis and worse clinical outcomes. Several studies have demonstrated the feasibility, safety and effectiveness of vitamin D supplementation strategies to improve vitamin D body content, but conflictual results support its benefit in general populations of critically ill patients. In contrast, small randomised clinical trials reported that vitamin D supplementation may improve host-defence to pathogen invasion via the production of cathelicidin and specific cytokines. Nonetheless, no large scale investigations have been designed to specifically assess the impact of vitamin D supplementation on the outcome of critically ill septic patients admitted to the intensive care unit.
严重感染常常需要入住重症监护病房，并在危重症患者中引发危及生命的并发症。在这种情况下，严重感染被认为是脓毒症发生的先决条件，脓毒症的病理生理学意味着宿主对病原体的反应失调，在全球范围内导致残疾和死亡。维生素D是一种甾醇类激素，在维持免疫系统稳态方面发挥着关键作用，这对于解决感染和调节脓毒症负担至关重要。具体而言，危重症患者中维生素D缺乏的情况已被广泛报道，并且是发生严重感染、脓毒症及更差临床结局的一个危险因素。多项研究已经证明了补充维生素D策略在提高维生素D体内含量方面的可行性、安全性和有效性，但相互矛盾的结果支持其在危重症患者总体人群中的益处。相比之下，小型随机临床试验报告称，补充维生素D可能通过产生抗菌肽和特定细胞因子来改善宿主对病原体入侵的防御能力。尽管如此，尚未设计大规模研究来专门评估补充维生素D对入住重症监护病房的危重症脓毒症患者结局的影响。
