维生素D缺乏对老年重症监护患者预后的影响

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

目的调查老年重症监护室患者维生素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月入住我院老年重症监护室的患者213例，检测血清25羟维生素D[25（0H）D]水平，比较25（0H）D充足组、不足组和缺乏组之间主要生化指标、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、30d住院死亡率；多因素Logistic回归分析影响老年重症监护室患者预后的独立因素。结果老年重症监护室患者维生素D缺乏82例（38．5％），不足90例（42．3％），充足41例（19．2％）。维生素D缺乏组与充足组比较，APACHEⅡ评分[（21．7±8．9）分比（17．1±8．0）分，P〈0．051、血浆乳酸[（1．89±0．76）mmol／L比（1．86±1．03）mmol／L，P〈0．051、C反应蛋白（CRP）[（101．1±48．2）mg／L比（92．5土38．6）mg／L，P〈O．053均较高，MODS发生率（42．7％比19．5％，P〈0．05）及死亡率（30．50比9．8％，P〈0．05）均较高。多因素分析提示维生素D缺乏是影响老年重症监护室患者预后的独立危险因素。血清25（0H）D水平与存活组重症监护室留住时间呈负相关（r=-0．18，P〈0．05）。结论老年重症监护室患者维生素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 patients in geriatric intensive care unit and the impact of vitamin D deficiency on the prognosis. Methods 213 hospitalized patients admitted into geriatric intensive care unit of Xinhua Hospital, Shanghai from June 2012 to December 2013 were included in the historical cohort study. Serum 25-hydroxyvitamin D [25 （OH）D]was examined in all the subjects. Main laboratory findings, the incidence of multiple organ dysfunction syndrome （MODS）, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ ） score and mortality rate of 30-day kept in hospital were compared among patients with different serum 25-hydroxyvitamin D level. Potential risk factors for mortality were analyzed by multivariate logistic regression analysis. Results 25（OH）D deficiency was identified in 82 patients （38.5%）, 25（0H）D insufficiency in 90 patients （42.3%）,and 25（OH）D sufficiency in 41 patients （19.2%）. Compared with 25（0H）D sufficiency group, 25（0H）D deficiency group showed the increased levels of APACHE II score, plasma lactic acid, C reactive protein （CPR）, the incidence of MODS and mortality rate （21.65!8.89 vs 17. 05±8. 03, 1.89±0.76mmol/Lw 1.86±l. 03mmol/L, 101.08±48.23mg/L vs 92.48±38.56 mg/L, 42.7% vs 19.5%, 30.50% vs 9.8%, all P〈0.05） . Multiple logistic regression analysis suggested that 25（OH）D deficiency was an independent risk factor for mortality. 25（OH）D levels were negatively correlated with length of stay in geriatric intensive care unit （r=- 0. 18, P〈O. 05）. Conclusions Vitamin D deficiency is highly prevalent among patients admitted into geriatric intensive care unit. Vitamin D deficiency is associated with disease severity and may be an independent risk factor for mortality.