Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill.
Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill.
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DOI：
10.1097/ccm.0b013e318206ccdf
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发表时间：
2011-04
影响因子：
8.8
通讯作者：
Christopher KB
中科院分区：
文献类型：
--
作者：
Braun A;Chang D;Mahadevappa K;Gibbons FK;Liu Y;Giovannucci E;Christopher KB
我们假设入院前缺乏25-羟基维生素D(25(OH)D)将与危重病人的所有原因死亡相关。内科和外科重症监护病房治疗患者的多中心观察性研究。马萨诸塞州波士顿两家教学医院的209张内科和外科重症监护床位2,399名患者，年龄18岁，其中25(≥)D是在1998年至2009年住院前测量的。入院前25(OH)D分为25(OH)D不足(≤15 ng/mL)、不足(16~29 ng/m L)和充足(≥30 ng/m L)。Logistic回归分析ICU入院后30、90和365天的死亡率、住院死亡率和血培养阳性率。调整后的优势比由多变量Logistic回归模型估计。入院前无25(OH)D缺乏对短期和长期死亡率有预测作用。ICU入院30天后，25(OH)D缺乏的患者与25(OH)D充足的患者相比，死亡率的OR为1.69(95%CI，1.28-2.23；P<；0.0001)。经多因素调整后，25(OH)D缺乏仍然是ICU入院后30天死亡率的重要预测因素(调整后的OR1.69；95%CI，1.26-2.26；P<；0.0001)。入院30天后，25(OH)D不足的患者与25(OH)D不足的患者相比，其OR值为1.32(95%可信区间为1.02~1.72；P=0.036)，调整后的OR为1.36(95%可信区间为1.03~1.79；P=0.029)。ICU入院后90天和365天的结果与住院死亡率相似。在对抽血培养的患者(n=1,160)进行的亚组分析中，25(OH)D缺乏与血培养阳性的风险增加相关。25(OH)D缺乏患者血培养阳性的OR值为1.64(95%CI1.05~2.55；P=0.03)，经多因素调整后仍显著高于25(OH)D充足患者：OR1.58(95%CI1.01~2.49；P=0.048)。在危重病患者群体中，入院前25(OH)D缺乏是短期和长期全因患者死亡率和血培养阳性的重要预测指标。
We hypothesized that deficiency in 25-hydroxy vitamin D (25(OH)D) prior to hospital admission would be associated with all cause mortality in the critically ill. Multicenter observational study of patients treated in medical and surgical intensive care units. 209 medical and surgical intensive care beds in two teaching hospitals in Boston, Massachusetts 2,399 patients, age ≥ 18 years, in whom 25(OH)D was measured prior to hospitalization between 1998 and 2009. Pre-admission 25(OH)D was categorized as deficiency in 25(OH)D (≤15ng/mL), insufficiency (16–29ng/mL) and sufficiency (≥30ng/mL). Logistic regression examined death by days 30, 90 and 365 post-ICU admission, in hospital mortality and blood culture positivity. Adjusted odds ratios were estimated by multivariable logistic regression models. None Pre-admission 25(OH)D deficiency is predictive for short term and long term mortality. 30 days following ICU admission, patients with 25(OH)D deficiency have an OR for mortality of 1.69(95%CI, 1.28–2.23;P<.0001) relative to patients with 25(OH)D sufficiency. 25(OH)D deficiency remains a significant predictor of mortality at 30 days following ICU admission following multivariable adjustment (adjusted OR 1.69; 95%CI, 1.26–2.26;P<.0001). 30 days following ICU admission, patients with 25(OH)D insufficiency have an OR of 1.32(95%CI, 1.02–1.72; P=0.036) and an adjusted OR of 1.36(95%CI, 1.03–1.79;P=0.029) relative to patients with 25(OH)D sufficiency. Results were similar at 90 and 365 days following ICU admission and for in hospital mortality. In a subgroup analysis of patients who had blood cultures drawn (n=1,160), 25(OH)D deficiency was associated with increased risk of blood culture positivity. Patients with 25(OH)D insufficiency have an OR for blood culture positivity of 1.64(95%CI, 1.05–2.55;P=0.03) relative to patients with 25(OH)D sufficiency which remains significant following multivariable adjustment: OR 1.58(95%CI, 1.01–2.49;P=0.048). Deficiency of 25(OH)D prior to hospital admission is a significant predictor of short and long term all cause patient mortality and blood culture positivity in a critically ill patient population.