High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial
High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial
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DOI：
10.1016/j.jcte.2016.04.004
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发表时间：
2016-06-01
影响因子：
3
通讯作者：
Martin, Greg S.
中科院分区：
文献类型：
--
作者：
Han, Jenny E.;Jones, Jennifer L.;Martin, Greg S.
背景：在危重病患者中维生素D缺乏症的发生率很高。几项重症监护病房研究表明，维生素D缺乏[25羟基维生素D(25(OH)D)和20 ng/mL]与住院时间(LOS)、再住院率、败血症和死亡率增加有关。材料和方法：对机械通气的成人ICU患者进行先导性、双盲随机对照试验。受试者每天给予安慰剂、50000国际单位维生素D-3或100,000国际单位维生素D-3，连续5天(维生素D-3总剂量分别为250,000国际单位或500,000国际单位)。主要结果是口服研究药物后7天的血浆25(OH)D浓度。次要结果是血浆抗菌肽长春花碱(LL37)水平、医院LOS、SOFA评分、机械通气时间、住院死亡率、12周死亡率和医院获得性感染。结果：共纳入31名受试者，其中13人(43%)在入院时维生素D缺乏(25(OH)D水平和20 ng/ml)。25万国际单位和500,000国际单位的维生素D-3方案分别导致从基线到第7天的平均血浆25(OH)D浓度显著增加；与安慰剂组基本没有变化(21+/-11.2 ng/毫升)相比，数值分别上升到45.719.6ngmL和55.2ng.m L，p<；0.001。与安慰剂组(分别为25+/-14天和18+/-11天，36+/-19天；p=0.03)相比，250,000国际单位维生素D-3组和500,000国际单位维生素D-3组的住院时间随着时间的推移而显著减少。结论：在这项初步研究中，大剂量维生素D-3安全地将血浆25(OH)D浓度增加到足够的范围，并与减少住院时间有关，而不会改变其他临床结果。(C)2016年提交人(S)。由爱思唯尔公司出版。
Background: There is a high prevalence of vitamin D deficiency in the critically ill patient population. Several intensive care unit studies have demonstrated an association between vitamin D deficiency [25hydroxyvitamin D (25(OH) D) < 20 ng/mL] and increased hospital length of stay (LOS), readmission rate, sepsis and mortality.Material and Methods: Pilot, double blind randomized control trial conducted on mechanically ventilated adult ICU patients. Subjects were administered either placebo, 50,000 IU vitamin D-3 or 100,000 IU vitamin D-3 daily for 5 consecutive days enterally (total vitamin D-3 dose = 250,000 IU or 500,000 IU, respectively). The primary outcome was plasma 25(OH) D concentration 7 days after oral administration of study drug. Secondary outcomes were plasma levels of the antimicrobial peptide cathelicidin (LL37), hospital LOS, SOFA score, duration of mechanical ventilation, hospital mortality, mortality at 12 weeks, and hospital acquired infection.Results: A total of 31 subjects were enrolled with 13 (43%) being vitamin D deficient at entry (25(OH) D levels < 20 ng/mL). The 250,000 IU and 500,000 IU vitamin D-3 regimens each resulted in a significant increase in mean plasma 25(OH) D concentrations from baseline to day 7; values rose to 45.7 +/- 19.6 ng/mL and 55.2 +/- 14.4 ng/mL, respectively, compared to essentially no change in the placebo group (21 +/- 11.2 ng/mL), p < 0.001. There was a significant decrease in hospital length of stay over time in the 250,000 IU and the 500,000 IU vitamin D-3 group, compared to the placebo group (25 +/- 14 and 18 +/- 11 days compared to 36 +/- 19 days, respectively; p = 0.03). There was no statically significant change in plasma LL-37 concentrations or other clinical outcomes by group over time.Conclusions: In this pilot study, high-dose vitamin D-3 safely increased plasma 25(OH) D concentrations into the sufficient range and was associated with decreased hospital length of stay without altering other clinical outcomes. (C) 2016 The Author( s). Published by Elsevier Inc.