脓毒症／严重脓毒症患儿维生素D水平与预后

Relationship of vitamin D in children with sepsis/severe sepsis and outcomes in PICU

目的了解儿童重症监护病房（pediatricintensivecareunit，PICU）脓毒症／严重脓毒症患儿维生素D缺乏程度；分析患者人院时维生素D水平与预后之间的关系。方法本研究为多中心、前瞻性、观察性研究。以2013年3月1日至2014年3月30日期间入住3家儿童医院PICU符合危重症标准的脓毒症／严重脓毒症患儿作为研究对象。入组患者入院24h内留取静脉血2mL，采用酶联免疫法检测血清25（OH）维生素D水平。根据维生素D水平，将患者分为维生素D充足、轻度维生素D缺乏和重度维生素D缺乏三组。分析入院时维生素D水平与PICU住院时间、总住院时间、出院病死率、28d病死率和经济费用之间的关系。结果共纳入病例194例。其中男117例（60．3％），女77例（39．7％）。脓毒症／严重脓毒症患分别为96例和98例。出院病死率和28d病死率分别为6．7％和24．2％。入院时中位维生素D水平9．79ng／mL（5．32，18．46）ng／mL，维生素D缺乏率77．8％（151／194），其中重度维生素D缺乏率达50．5％（98／194）。入院时存在重度维生素D缺乏的患者出院病死率显著增加（P=0．011）。维生素D水平与PICU住院时间、总住院时间和经济花费间没有进行相关分析。结论PICU脓毒症／严重脓毒症儿童中维生素D缺乏率高达77．8％；重度维生素D缺乏患者，出院病死率更高。

Objective To determine the vitamin D status in children with sepsis/severe sepsis in pediatric intensive care unit （PICU） in order to explor the association between vitamin D status and clinical outcomes, in turn to provide evidence for optimizing nutrition support. Methods It was a prospective, observational, muhi-center study, carried out in patients with sepsis/severe sepsis from March 1, 2013, to March 30, 2014, in the PICUs of three tertiary-care children＇ s hospitals. Total serum 25-hydroxy vitamin D [25 （OH） D] was measured by using an enzyme-linked immunosorbent assay at admission. The association of vitamin D status at admission with length of PICU length of stay, total hospital stay, in-hospital mortality, 28-days mortality and costs were analyzed. Results A total of 194 patients includng 117 boys （60. 3% ） and 77 girls （39. 7% ） were enrolled. There were 96 patients with sepsis and 98 with severe sepsis. The mortality on discharge and 28 days were 6. 7% and 24. 2% respectively. The median vitamin D level was 9.79 ng/mL （5.32, 18.46） at admission. Of them 77.8% （151/194） had vitamin D deficiency and 50. 5% （98/194） had severe vitamin D deficiency. Patients with severe vitamin D deficiency, had higher mortality on discharge （ P = 0. 011 ） . Vitamin D status had no significant correlations with 28 days mortality, length of PICU stay, total hospital stay and costs. Conclusions More than three-quarters （77.8%） of children with sepsis/severe sepsis in PICUs had Vitamin D deficiency. Patients with severe vitamin D deficiency at admission had higher risk of mortality at discharge.