Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients.
Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients.
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DOI：
10.1016/j.amjsurg.2011.07.021
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发表时间：
2012-07
影响因子：
3
通讯作者：
Danner, Omar K.
中科院分区：
文献类型：
--
作者：
Matthews, L. Ray;Ahmed, Yusuf;Wilson, Kenneth L.;Griggs, Diane D.;Danner, Omar K.
维生素 D 缺乏症是美国最常见的营养缺乏症。它很少被测量或识别，也很少被治疗，特别是对于危重患者。本研究的目的是调查外科重症监护室患者维生素 D 缺乏的患病率和影响。我们假设严重维生素 D 缺乏会增加重症监护室重症患者的住院时间、死亡率和费用。我们对 2009 年 8 月至 2010 年 1 月期间入住格雷迪纪念医院外科重症监护室的 258 名连续患者进行了维生素 D 状态的前瞻性观察研究。通过高压液相色谱和串联质谱法测量维生素 D 水平（25 [OH]2 维生素-D3）。维生素D缺乏的定义如下：严重缺乏为低于13ng/mL；中度缺乏被归类为 14 至 26 ng/mL；轻度缺乏为 27 至 39 ng/mL；正常水平被归类为大于 40 ng/mL。在接受评估的 258 名患者中，70.2%（181 名）为男性，29.8%（77 名）为女性； 57.6% (148) 是非裔美国人，32.4% (109) 是白种人。共有 138 名患者（53.5%）患有严重维生素 D 缺乏症，96 名患者（37.2%）患有中度缺乏症，18 名患者（7.0%）患有轻度缺乏症，其中 3 名患者（1.2%）维生素 D 水平正常。严重维生素 D 缺乏组在外科重症监护室的平均住院时间为 13.33 ± 19.5 天，而中度和轻度维生素 D 缺乏组分别为 7.29 ± 15.3 天和 5.17 ± 6.5 天，这具有临床意义 (P = .002)。严重维生素 D 缺乏组患者在外科重症监护病房期间的平均治疗费用为 51,413.33 ± 75,123.00 美元，中度维生素 D 缺乏组为 28,123.65 ± 59,752.00 美元，轻度维生素 D 缺乏组为 20,414.11 ± 25,714.30 美元，这也具有临床意义（P = .027）。更重要的是，维生素 D 严重缺乏组的死亡率为 17 例 (12.3%)，而中度维生素 D 缺乏组的死亡率为 11 例 (11.5%) (P = .125)。由于轻度或正常维生素 D 缺乏组中没有发生死亡，因此我们比较了重度/中度维生素 D 缺乏组和轻度/正常维生素 D 缺乏组之间的死亡率 (P = .047)。在单变量分析中，与轻度维生素 D 缺乏组相比，调整年龄、性别、种族和年龄后，严重和中度维生素 D 缺乏与外科重症监护病房的住院时间呈负相关 (r = .194; P = .001)，与外科重症监护病房的治疗费用 (r = .194; P = .001) 和死亡率 (r = .125; P = .023) 呈负相关。合并症（心肌梗塞、急性肾衰竭和肺炎）；住院时间、外科重症监护病房费用和死亡率仍然与维生素 D 缺乏显着相关。
Vitamin D deficiency is the most common nutritional deficiency in the United States. It is seldom measured or recognized, and rarely is treated, particularly in critically ill patients. The purpose of this study was to investigate the prevalence and impact of vitamin D deficiency in surgical intensive care unit patients. We hypothesized that severe vitamin D deficiency increases the length of stay, mortality rate, and cost in critically ill patients admitted to surgical intensive care units. We performed a prospective observational study of vitamin D status on 258 consecutive patients admitted to the Surgical Intensive Care Unit at Grady Memorial Hospital between August 2009 and January 2010. Vitamin D levels (25 [OH]2 vitamin-D3) were measured by high-pressure liquid chromatography and tandem mass spectrometry. Vitamin D deficiency was defined as follows: severe deficiency was categorized as less than 13 ng/mL; moderate deficiency was categorized as 14 to 26 ng/mL; mild deficiency was categorized as 27 to 39 ng/mL; and normal levels were categorized as greater than 40 ng/mL. Of the 258 patients evaluated, 70.2% (181) were men, and 29.8% (77) were women; 57.6% (148) were African American and 32.4% (109) were Caucasian. A total of 138 (53.5%) patients had severe vitamin D deficiency, 96 (37.2%) had moderate deficiency, 18 (7.0%) had mild deficiency, and 3 (1.2%) of the patients had normal vitamin D levels. The mean length of stay in the Surgical Intensive Care Unit for the severe vitamin D–deficient group was 13.33 ± 19.5 days versus 7.29 ± 15.3 days and 5.17 ± 6.5 days for the moderate and mild vitamin D-deficient groups, respectively, which was clinically significant (P = .002). The mean treatment cost during the patient stay in the surgical intensive care unit was $51,413.33 ± $75,123.00 for the severe vitamin D–deficient group, $28,123.65 ± $59,752.00 for the moderate group, and $20,414.11 ± $25,714.30 for the mild vitamin D–deficient group, which also was clinically significant (P = .027). More importantly, the mortality rate for the severe vitamin D–deficient group was 17 (12.3%) versus 11 (11.5%) in the moderate group (P = .125). Because no deaths occurred in the mildly or normal vitamin D–deficient groups, we compared the mortality rate between severe/moderate and mild/normal vitamin D groups (P = .047). In univariate analysis, severe and moderate vitamin D deficiency was related inversely to the length of stay in the surgical intensive care unit (r = .194; P = .001), related inversely to surgical intensive care unit treatment cost (r = .194; P = .001) and mortality (r = .125; P = .023), compared with the mild vitamin D–deficient group, after adjusting for age, sex, race, and comorbidities (myocardial infarctions, acute renal failure, and pneumonia); the length of stay, surgical intensive care unit cost, and mortality remained significantly associated with vitamin D deficiency.
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影响因子：
56.9
作者：
Liu, PT;Stenger, S;Modlin, RL
通讯作者：
Modlin, RL
影响因子：
38.9
作者：
Lee, Paul;Nair, Priya;Center, Jacqueline R.
通讯作者：
Center, Jacqueline R.
影响因子：
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作者：
Melamed, Michal L.;Michos, Erin D.;Post, Wendy;Astor, Brad
通讯作者：
Astor, Brad
影响因子：
5.8
作者：
Holick, MF;Siris, ES;de Papp, AE
通讯作者：
de Papp, AE
DOI：
10.3122/jabfm.2009.06.090037
发表时间：
2009-11-01
影响因子：
2.9
作者：
Kulie, Teresa;Groff, Amy;Schrager, Sarina
通讯作者：
Schrager, Sarina