Prevalence of vitamin deficiencies on admission: relationship to hospital mortality in critically ill patients
Prevalence of vitamin deficiencies on admission: relationship to hospital mortality in critically ill patients
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DOI：
10.1177/0310057x0903700215
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发表时间：
2009-03-01
影响因子：
1.5
通讯作者：
Ho, K. M.
中科院分区：
文献类型：
--
作者：
Corcoran, T. B.;O'Neill, M. A.;Ho, K. M.
维生素缺乏被认为在危重疾病中很常见。水溶性维生素和抗氧化维生素是这些患者最常用的补充剂。没有数据证实维生素缺乏症在高危急诊重症监护患者中的普遍存在，也没有数据证实维生素缺乏症与医院死亡率的关系。这项前瞻性观察队列研究纳入了129名紧急入住重症监护的危重患者。前瞻性地收集患者资料，包括诊断、入院来源和疾病严重程度评分。入院前48小时内，测定动脉血中c反应蛋白、维生素A、E、B-1、B-12和叶酸的浓度。采用多变量逐步logistic回归模型来检验维生素浓度与住院死亡率的关系。55名患者（43%）在进入重症监护室时存在五种维生素之一的生化缺乏。共有18名患者（14%）在住院期间死亡（其中15名在重症监护病房）。维生素b121 A和E与c反应蛋白浓度呈中等相关性（Spearman’s r分别为0.309、-0.541和-0.299，P分别为0.001、0.001和0.007）。在单变量分析中，住院死亡率与年龄、APACHE II评分、入院和最大序贯器官衰竭评估评分以及入院来源显著相关。多变量分析未显示生化缺乏与死亡率之间的关联。水溶性维生素和抗氧化维生素的生化缺陷是在计划外或急诊入住重症监护室的常见病例，但我们无法证明其与住院死亡率的独立关联。
Vitamin deficiency is believed to be common in critical illness. Water soluble and antioxidant vitamins are those most frequently used for supplementation in these patients. There are no data to confirm the prevalence of vitamin deficiencies in high-risk emergently admitted intensive care patients, nor their association with hospital mortality.One hundred and twenty-nine consecutive, critically ill patients who were emergently admitted to intensive care were enrolled in this prospective observational cohort study. Patient data including diagnosis, source of admission and severity of illness scores were prospectively collected. Within the first 48 hours of admission, concentrations Of C-reactive protein, Vitamins A, E, B-1, B-12 and folate were measured oil arterial blood. Multivariate stepwise logistic regression modelling was performed to examine the association of vitamin concentrations with hospital mortality. Fifty-five patients (43%) had a biochemical deficiency of one of the five vitamins on admission to the intensive care unit. A total of 18 patients died (14%) during their hospital stay (15 of those in the intensive care unit). Moderate correlations with C-reactive protein concentrations were demonstrated for Vitamins B 121 A and E (Spearman's r=0.309, -0.541 and -0.299, P=0.001, 0.001 and 0.007 respectively). Hospital mortality was significantly associated with age, APACHE II score, admission and maximum Sequential Organ Failure Assessment scores and admission source in the univariate analyses. Multivariate analysis did not demonstrate an association between biochemical deficiency and mortality. Biochemical deficiencies of water-soluble and antioxidant vitamins are common oil admission in unplanned or emergency admissions to the intensive care unit, but we could not demonstrate an independent association with hospital mortality.