Saric Lenko, Domazet Bugarin Josipa, Dosenovic Svjetlana
Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, 21000 Split, Croatia.
University Department of Health Studies, University of Split, 21000 Split, Croatia.
Nutrients. 2024 Dec 31;17(1):156. doi: 10.3390/nu17010156.
Studies have shown a high prevalence of vitamin D deficiency in critically ill patients, and these patients are at higher risk for pneumonia and have increased incidence of sepsis and mortality. In this study, we reviewed available literature from randomized controlled trials (RCTs) on vitamin D supplementation in critically ill patients and summarized the evidence in this narrative review.
Randomized controlled trials that included vitamin D supplementation as an intervention were eligible for inclusion. No limits were set regarding vitamin D dosage or route of administration, as well as for primary and secondary outcomes. A search was conducted in MEDLINE via PubMed for eligible RCTs. References from systematic reviews (SRs) and meta-analyses (MAs) were screened, and Clinicaltrials.gov was searched for ongoing studies.
A total of 21 RCTs involving 3166 patients were analyzed. There was a large heterogeneity in terms of patients' characteristics and inclusion criteria. Only six studies included patients with vitamin D levels < 50 nmol/L. Regarding clinically important outcomes, most of the studies did not show differences between the intervention and control group in terms of mortality, intensive care unit (ICU) or hospital length of stay (LoS).
There is great variability in trial designs regarding the selection of patients, dosage, dosing intervals and routes of administration of vitamin D supplements. Better study designs are mandatory for future clinical research, with measuring and reporting basal vitamin D levels before randomization. Since variability in supplementation regimes limits the possibility of data synthesis, standardized protocols for vitamin D supplementation should be used in clinical trial settings.
研究表明，重症患者中维生素D缺乏的患病率很高，这些患者患肺炎的风险更高，败血症发病率和死亡率也有所增加。在本研究中，我们回顾了关于重症患者补充维生素D的随机对照试验（RCT）的现有文献，并在本叙述性综述中总结了证据。
纳入以补充维生素D作为干预措施的随机对照试验。对维生素D剂量、给药途径以及主要和次要结局均无限制。通过PubMed在MEDLINE中检索符合条件的随机对照试验。筛选系统评价（SR）和荟萃分析（MA）的参考文献，并在Clinicaltrials.gov中检索正在进行的研究。
共分析了21项涉及3166例患者的随机对照试验。患者特征和纳入标准存在很大异质性。只有六项研究纳入了维生素D水平<50 nmol/L的患者。关于临床重要结局，大多数研究在死亡率、重症监护病房（ICU）或住院时间（LoS）方面未显示干预组和对照组之间存在差异。
在维生素D补充剂的患者选择、剂量、给药间隔和给药途径的试验设计方面存在很大差异。未来的临床研究必须采用更好的研究设计，在随机分组前测量和报告基础维生素D水平。由于补充方案的差异限制了数据合成的可能性，因此在临床试验中应使用标准化的维生素D补充方案。
