Gonçalves Ana Moura, Rodrigues Bárbara Sucena, Antunes Maria Lobo, Gonçalves João, Marinho António
Department of Intensive Care Medicine, Hospital Beatriz Ângelo, Loures, Portugal.
Faculty of Pharmacy, University of Lisbon iMed - Research Institute of Medicines, Lisbon, Portugal.
Front Immunol. 2025 Jun 5;16:1593200. doi: 10.3389/fimmu.2025.1593200. eCollection 2025.
Research suggests that patients with low vitD levels are more susceptible to severe SARS-CoV-2 infections with need for hospitalization and admission to an intensive care unit (ICU). Our objectives were to evaluate the impact of cholecalciferol supplementation in critical care patients with severe SARS-CoV-2 pneumonia in regards to prognosis, evolution of organ failure and need for organ support.
A nonblinded controlled trial was conducted in patients with severe SARS-CoV-2 pneumonia admitted to the ICU. Patients were randomized by block of two, into three groups (no cholecalciferol, 500MU cholecalciferol arm, 2MU/day cholecalciferol during ICU stay and remaining hospitalization). Serum 25-hydroxyvitamin D levels were measured and correlated with organ failure indicators (based on SOFA), ICU length of stay, need for organ support, days on mechanical ventilation and ICU, intra-hospital and 60 day mortality.
207 patients were included. The number of organ failures showed a significant negative correlation with 25vitD levels on admission (r= -0.208, p=0.005), on the third day (r= -0.312, p<0,001), and on the seventh day(r= -0.224, p=0.01). In the group of patients supplemented with 500MU of cholecalciferol there was a significant negative correlation between the number of organ failures and 25vitD levels on third day (r= -0.454, p<0.001).
Lower vitD levels on admission were related to more organ failures and high doses cholecalciferol supplementation was related to lower organ failures. More studies are needed to evaluate the impact of baseline vitD levels on clinical outcome and prognosis, to identify potential subpopulations that can benefit from supplementation and to understand the impact of critical illness on cholecalciferol action and protective effect.
研究表明，维生素D水平低的患者更容易感染严重的SARS-CoV-2，需要住院并入住重症监护病房（ICU）。我们的目标是评估补充胆钙化醇对患有严重SARS-CoV-2肺炎的重症患者的预后、器官功能衰竭的演变以及器官支持需求的影响。
对入住ICU的严重SARS-CoV-2肺炎患者进行了一项非盲对照试验。患者按2人一组进行随机分组，分为三组（不补充胆钙化醇、500MU胆钙化醇组、在ICU住院期间及剩余住院期间每天补充2MU胆钙化醇）。测量血清25-羟基维生素D水平，并将其与器官功能衰竭指标（基于序贯器官衰竭评估（SOFA））、ICU住院时间、器官支持需求、机械通气天数以及ICU、院内和60天死亡率相关联。
纳入207例患者。入院时（r = -0.208，p = 0.005）、第三天（r = -0.312，p < 0.001）和第七天（r = -0.224，p = 0.01），器官功能衰竭的数量与25维生素D水平呈显著负相关。在补充500MU胆钙化醇的患者组中，第三天器官功能衰竭的数量与25维生素D水平之间存在显著负相关（r = -0.454，p < 0.001）。
入院时较低的维生素D水平与更多的器官功能衰竭相关，高剂量补充胆钙化醇与较低的器官功能衰竭相关。需要更多的研究来评估基线维生素D水平对临床结局和预后的影响，确定可能从补充中获益的潜在亚组，并了解危重病对胆钙化醇作用和保护效果的影响。
