Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality.
Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality.
复制标题
在重症监护开始时，低血清25-羟基维生素D与死亡率增加有关。
DOI：
10.1097/ccm.0b013e31822d74f3
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发表时间：
2012-01
影响因子：
8.8
通讯作者：
Christopher KB
中科院分区：
文献类型：
--
作者：
Braun AB;Gibbons FK;Litonjua AA;Giovannucci E;Christopher KB
我们假设，重症监护初期缺乏25-羟基维生素D将与所有原因的死亡相关。双中心观察性研究。马萨诸塞州波士顿的两家教学医院在1998年至2009年期间对1,325名患者进行了25-羟基维生素D的检测，这些患者的年龄为18岁，分别是在重症监护开始之前或之后的7天。25-羟基维生素D分为25-羟基维生素D缺乏(≤15 ng/mL)、不足(16~29 ng/mL)和充足(≥30 ng/mL)。Logistic回归分析了危重病护理开始后30、90和365天的死亡率和住院死亡率。调整后的优势比由多变量Logistic回归模型估计。非25-羟基维生素D缺乏症可预测短期和长期死亡率。重症监护开始后30天，25羟基维生素D缺乏的患者与25羟基维生素D充足的患者相比，死亡率的OR为1.85(95%CI，1.15-2.98；P=0.01)。在对年龄、性别、种族、Deyo-Charlson指数、脓毒症、季节和外科与内科患者类型进行多变量调整后，25羟基维生素D缺乏仍然是重症监护开始后30天死亡率的重要预测因素(调整后的OR为1.94；95%CI为1.18-3.20；P=0.01)。在重症监护开始后的90天和365天以及住院死亡率方面，结果也同样显著。维生素D和死亡率之间的联系不会因败血症、种族或社区贫困率(社会经济地位的替代指标)而改变。在危重病患者群体中，在开始危重护理时缺乏25-羟基维生素D是所有原因患者死亡率的重要预测因子。
We hypothesized that deficiency in 25-hydroxy vitamin D at critical care initiation would be associated with all cause mortality. Two-center observational study. Two teaching hospitals in Boston, Massachusetts 1,325 patients, age ≥ 18 years, in whom 25-hydroxy vitamin D was measured 7 days prior to or after critical care initiation between 1998 and 2009. 25-hydroxy vitamin D was categorized as deficiency in 25-hydroxy vitamin D (≤15 ng/mL), insufficiency (16–29 ng/mL) and sufficiency (≥30 ng/mL). Logistic regression examined death by days 30, 90 and 365 post-critical care initiation and in hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models. None 25-hydroxy vitamin D deficiency is predictive for short term and long term mortality. 30 days following critical care initiation, patients with 25-hydroxy vitamin D deficiency have an OR for mortality of 1.85 (95% CI, 1.15–2.98;P=0.01) relative to patients with 25-hydroxy vitamin D sufficiency. 25-hydroxy vitamin D deficiency remains a significant predictor of mortality at 30 days following critical care initiation following multivariable adjustment for age, gender, race, Deyo-Charlson index, sepsis, season, and surgical versus medical patient type (adjusted OR 1.94; 95% CI, 1.18–3.20;P=0.01). Results were similarly significant at 90 and 365 days following critical care initiation and for in hospital mortality. The association between vitamin D and mortality was not modified by sepsis, race, or Neighborhood poverty rate, a proxy for socioeconomic status. Deficiency of 25-hydroxy vitamin D at the time of critical care initiation is a significant predictor of all cause patient mortality in a critically ill patient population.