Gulišija Jelena, Čapkun Vesna, Golic Stefan, Stojanović Stipić Sanda
Department of Neurology, University Hospital of Split, 21000 Split, Croatia.
Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia.
Pathophysiology. 2025 May 9;32(2):21. doi: 10.3390/pathophysiology32020021.
: The pathogenesis of intensive care unit-acquired weakness (ICU-AW) is multi-factorial, with some of the main risk factors being sepsis, multiorgan failure, and the inflammatory response related to critical illness. Vitamin D is crucial for muscle function, the immune response, and inflammation, and has been identified as a predictor of negative outcomes in intensive care unit (ICU) patients with COVID-19. The objective of this preliminary study was to examine the relationship between vitamin D serum levels and the incidence of ICU-AW in a cohort from the University Hospital of Split. : A prospective observational cohort study was conducted in the University Hospital of Split in ICU from December 2021 to March 2022. The inclusion criteria were as follows: patients over 18 years old who had a confirmed severe acute respiratory coronavirus disease 2 (SARS-CoV-2) infection, patients who were mechanically ventilated for more than 48 h, and patients who were weaned from a ventilator over at least 24 h. The exclusion criteria were a history of neurological or musculoskeletal disorders and a pre-existing poor functional status. Vitamin D was detected in the first routine blood sample. : A total of 77 patients were observed, with 36 patients who were successfully weaned from a ventilator over at least 24 h and 1 patient who could not be examined because of impaired consciousness (this patient was excluded from further analysis), and thus a total of 35 patients were analyzed. Of these 35 patients, 12 (34%) developed ICU-AW. The median vitamin D serum level in the ICU-AW group was 17 (7.5-73.3), while that in the non-ICU-AW group was 25.2 (12.3-121). The difference in vitamin D serum levels between the groups was not significantly different from zero ( = 0.567). All patients, except for one, were vitamin D insufficient. : Vitamin D serum levels in the ICU-AW group were not statistically different from the non-ICU-AW group, possibly due to the small sample size. Given the known roles of vitamin D in muscle function, immune modulation, and inflammation, a potential etiopathogenetic role in ICU-AW cannot be excluded without additional studies. Therefore, further studies with larger sample sizes than ours are necessary to determine whether vitamin D deficiency contributes to the development of ICU-AW and whether supplementation could have preventive or therapeutic value.
重症监护病房获得性肌无力（ICU-AW）的发病机制是多因素的，一些主要危险因素包括败血症、多器官功能衰竭以及与危重病相关的炎症反应。维生素D对肌肉功能、免疫反应和炎症至关重要，并且已被确定为新型冠状病毒肺炎（COVID-19）重症监护病房（ICU）患者不良结局的预测指标。这项初步研究的目的是在斯普利特大学医院的一个队列中研究维生素D血清水平与ICU-AW发病率之间的关系。
2021年12月至2022年3月，在斯普利特大学医院的ICU进行了一项前瞻性观察队列研究。纳入标准如下：年龄超过18岁且确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的患者、机械通气超过48小时的患者以及脱机至少24小时的患者。排除标准为有神经或肌肉骨骼疾病史以及既往功能状态不佳。在首次常规血样中检测维生素D。
共观察了77例患者，其中36例成功脱机至少24小时，1例因意识障碍无法检查（该患者被排除在进一步分析之外），因此共分析了35例患者。在这35例患者中，12例（34%）发生了ICU-AW。ICU-AW组维生素D血清水平中位数为17（7.5-73.3），而非ICU-AW组为25.2（12.3-121）。两组之间维生素D血清水平差异与零无显著差异（P = 0.567）。除1例外，所有患者维生素D均不足。
ICU-AW组维生素D血清水平与非ICU-AW组无统计学差异，可能是由于样本量小。鉴于维生素D在肌肉功能、免疫调节和炎症方面的已知作用，在没有进一步研究的情况下，不能排除其在ICU-AW中的潜在病因学作用。因此，需要进行比我们样本量更大的进一步研究，以确定维生素D缺乏是否会导致ICU-AW的发生，以及补充维生素D是否具有预防或治疗价值。
