Vitamin D measurement and effect on outcome in a cohort of patients with heart failure.
Vitamin D measurement and effect on outcome in a cohort of patients with heart failure.
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DOI：
10.1530/ec-18-0207
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发表时间：
2018-09-01
影响因子：
2.9
通讯作者：
Zucchi R
中科院分区：
文献类型：
--
作者：
Saponaro F;Saba A;Frascarelli S;Frontera C;Clerico A;Scalese M;Sessa MR;Cetani F;Borsari S;Pardi E;Marvelli A;Marcocci C;Passino C;Zucchi R
本文的目的是评估与对照组相比，心力衰竭（HF）患者的维生素D（VitD）水平，以评估VitD对HF结局的影响，并比较LIAISON免疫测定法和HPLC-MS-MS方法在该人群中的VitD测量。我们收集了247例HF患者的临床、生化和结果数据，在151例患者的亚组中，我们用LIAISON和HPLC-MS-MS测量了VitD。HF患者的25 OHD水平在统计学上较低（45.2 ± 23.7 nmol/L）和VitD缺乏的发生率显著高于对照组（58.2 ± 24.0 nmol/L，P < 0.001）（61.1%比39.5%，P < 0.001）和缺乏（24.7%比6.6%，P < 0.001）。基线25 OHD和HF相关死亡风险之间存在显著的负相关关系，HR为0.59（95%CI 0.37-0.92，P = 0.02），在多变量校正分析中得到证实。Kaplan-Meier生存分析显示，VitD不足与HF患者生存率降低相关（对数秩P = 0.017）。LIAISON法与HPLC-MS-MS法结果一致性较好（Cohen 'skappa系数0.70），但前者的VitD不足检出率明显高于后者（58.3%，n = 88 vs 55.6%，n = 84，P < 0.001）。与HPLC-MS-MS相比，LIAISON低估了25 OHD水平，平均相对偏倚为-0.739%，95%的一致性限度（-9.00至+7.52%）。HPLC-MS-MS充分测量的25 OHD水平在HF人群中较低，与HF相关死亡风险相关。
The aims of this paper were to evaluate the levels of Vitamin D (VitD) in patients with heart failure (HF), compared to a control group, to assess the effects of VitD on HF outcome and to compare VitD measurement between LIAISON immunoassay and HPLC-MS-MS methods in this population. We collected clinical, biochemical and outcome data from 247 patients with HF and in a subgroup of 151 patients, we measured VitD both with LIAISON and HPLC-MS-MS. HF patients had statistically lower 25OHD levels (45.2 ± 23.7 nmol/L vs 58.2 ± 24.0 nmol/L, P < 0.001) and a statistically higher prevalence of VitD insufficiency (61.1% vs 39.5%, P < 0.001) and deficiency (24.7% vs 6.6%, P < 0.001), compared to healthy controls. There was a significant inverse relationship between baseline 25OHD and risk of HF-related death, with a HR of 0.59 (95% CI 0.37–0.92, P = 0.02), confirmed in a multivariate adjusted analysis. Kaplan–Meier survival analyses showed that VitD insufficiency was associated with reduced survival in HF patients (log rank P = 0.017). There was a good agreement between LIAISON and HPLC-MS-MS (Cohen’s kappa coefficient 0.70), but the prevalence of VitD insufficiency was significantly higher with the former compared to the latter method (58.3%, n = 88 vs 55.6%, n = 84, P < 0.001). LIAISON underestimated the 25OHD levels and showed a mean relative bias of −0.739% with 95% of limits of agreement (−9.00 to +7.52%), when compared to HPLC-MS-MS. 25OHD levels adequately measured by HPLC-MS-MS showed to be low in HF population and to be correlated with HF-related risk of death.