维生素D对老年重症监护室患者预后的影响

Evaluation of vitamin D on prognosis for patients in geriatric intensive care unit

目的调查老年重症监护室(ICU)患者维生素D缺乏的情况,并探讨其对预后的影响。方法收集2012年6月至2013年12月入住新华医院老年ICU的患者213例,检测血清25羟维生素D[25(OH)D]水平,比较25(OH)D充足组、25(OH)D不足组和25(OH)D缺乏组组间主要生化指标、多器官功能障碍综合征(MODS)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分以及30 d住院死亡率的差异;同时运用多因素logistic回归分析影响老年ICU患者预后的独立危险因素。结果老年ICU患者维生素D缺乏82例(38.50%),维生素D不足90例(42.25%),维生素D充足41例(19.25%)。与维生素D充足组比较,维生素D缺乏组APACHEⅡ评分、血浆乳酸、C反应蛋白(CRP)水平均较高(P<0.05),MODS发生率和死亡率亦较高(P<0.05)。多因素分析提示维生素D缺乏是影响老年ICU患者预后的独立危险因素。血清25(OH)D水平与存活组ICU留住时间呈负相关(r=-0.18,P<0.05)。结论老年ICU患者维生素D缺乏普遍存在;维生素D缺乏与患者疾病的严重程度相关,可能是影响疾病预后的独立危险因素。

Objective To investigate the prevalence of vitamin D deficiency in geriatric intensive care unit（ICU）and its relationship with severity of disease and prognosis.Methods 213 inpatients of geriatric ICU in Xinhua Hospital from June 2012 to December 2013 were included in this historical cohort study.Serum level of 25-hydroxyvitamin D[25-（OH）D]was detected and analyzed.Main biochemistry index,the incidence of multiple organ dysfunction syndrome（MODS）,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score and mortality of 30-day kept in hospital were observed and compared among patients with different serum level of 25（OH） D.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results 25（OH） D deficiency,insufficiency,and sufficiency was identified in 82（38.50%）,90（42.25%）,and 41（19.25%） patients respectively.Compared with sufficiency group,APACHE Ⅱ score,plasma lactic acid,C reactive protein（CRP）,the incidence of MODS and mortality were higher in deficiency group（P〈0.05）.Multiple logistic regression suggested that 25（OH） D deficiency was an independent risk factor for mortality.The level of 25（OH） D was negatively correlated with length of stay in geriatric ICU（r=-0.18,P〈0.05）.Conclusions Vitamin D deficiency is highly prevalent among the patients admitted into geriatric ICU.Vitamin D deficiency is associated with disease severity and may be an independent risk factor for mortality.