PDF(Pubmed)
Abstract：
Hypovitaminosis D is highly prevalent in critically ill patients, and it has been suggested to be a risk factor for infections, sepsis and higher mortality. We sought to investigate whether serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) in critically ill patients with new onset sepsis are associated with severity and outcome. We prospectively included 50 consecutive critically ill adult cases with new onset sepsis and 50 healthy controls matched for age and sex. PTH and 25(OH)D were determined in serum via electrochemiluminescence immunoassays at inclusion in the study in all cases and controls, and one week after sepsis onset in cases. Patients had reduced 25(OH)D compared to controls at sepsis onset (7.9 ± 3 vs 24.6 ± 6.7 ng/mL, p < 0.001), whilst PTH was similar (median (range): 34.5 (5.7-218.5) vs 44.2 (14.2-98.1) pg/mL, p = 0.35). In patients, 25(OH)D upon enrollment and one week after did not differ significantly (7.9 ± 3 vs 7 ± 4.3 ng/mL, p = 0.19). All patients presented with hypovitaminosis D (25(OH)D < 20 ng/mL), while 40 patients (80 %) had vitamin D deficiency (25(OH)D < 12 ng/mL) at sepsis onset, including all ten (20 %) nonsurvivors, who died within 28 days from sepsis onset. Patients with sepsis (N = 28) and septic shock (N = 22) as well as survivors (N = 40) and nonsurvivors (N = 10) had similar 25(OH)D at enrollment (p > 0.05). 25(OH)D was positively correlated with ionized calcium (r = 0.46, p < 0.001) and negatively with PTH (p < 0.05), while inflammatory biomarkers or the severity scores exhibited no correlation with 25(OH)D. Patients with septic shock and nonsurvivors had lower PTH than patients with sepsis and survivors respectively (42.2 ± 42.9 vs 73.4 ± 61.9 pg/mL, p = 0.04, and 18.3 ± 10.7 vs 69.9 ± 58.8 pg/mL, p = 0.001, respectively). C-reactive protein was negatively associated with PTH (r = -0.44, p = 0.001). In conclusion, vitamin D deficiency was present in 80 % of critically ill patients at sepsis onset, while nonsurvivors exhibited lower PTH than survivors. Additional, larger and multicenter studies are warranted to elucidate the contribution of vitamin D and PTH to the pathogenesis of sepsis and its outcomes.
摘要：
维生素D缺乏症在危重患者中非常普遍，它被认为是感染的危险因素，脓毒症和更高的死亡率。我们试图调查新发脓毒症的危重患者的血清25-羟基维生素D（25（OH）D）和甲状旁腺激素（PTH）是否与严重程度和预后相关。我们前瞻性纳入了50例新发脓毒症的连续危重成人病例和50例年龄和性别相匹配的健康对照。在所有病例和对照的研究中，通过电化学发光免疫测定法测定血清中的PTH和25（OH）D。和脓毒症发病后一周的病例。与对照组相比，败血症发作时患者的25（OH）D降低（7.9±3vs24.6±6.7ng/mL，p<0.001)，而PTH相似（中位数（范围）：34.5（5.7-218.5）vs44.2（14.2-98.1）pg/mL，p=0.35)。在患者中，入组时和入组后一周的25（OH）D没有显着差异（7.9±3vs7±4.3ng/mL，p=0.19）。所有患者均出现维生素D缺乏症（25（OH）D<20ng/mL），而40例患者（80％）在脓毒症发作时维生素D缺乏（25（OH）D<12ng/mL），包括所有10名（20%）非幸存者，在脓毒症发病28天内死亡。败血症（N=28）和败血症性休克（N=22）患者以及幸存者（N=40）和非幸存者（N=10）在招募时具有相似的25（OH）D（p>0.05）。25(OH)D与离子钙呈正相关(r=0.46,p<0.001),与PTH呈负相关(p<0.05),而炎症生物标志物或严重程度评分与25(OH)D无相关性。败血症性休克和非幸存者患者的PTH分别低于败血症和幸存者（42.2±42.9vs73.4±61.9pg/mL，p=0.04，18.3±10.7对69.9±58.8pg/mL，分别为p=0.001)。C反应蛋白与PTH呈负相关(r=-0.44,p=0.001)。总之,维生素D缺乏存在于80％的脓毒症发病的危重患者，而非幸存者的PTH低于幸存者。额外,需要更大规模和多中心的研究来阐明维生素D和PTH在脓毒症发病机制及其结局中的作用.
