背景:越来越多的证据表明,维生素D缺乏与许多慢性非骨骼疾病的高风险相关。与年龄相关的疾病以及死亡率。
目的:为了确定,在年龄≥80岁的老年患者中,维生素D缺乏的患病率及其与共病的关系,实验室测试,入院时抽血后一年内的住院时间和死亡率。
方法:我们回顾性调查了830名老年患者的电子医院健康记录。记录的数据包括患者人口统计数据(例如,年龄,性别,逗留时间,再入院数,入院时抽血后一年内死亡),医学诊断,实验室结果,包括25-羟基维生素D[25(OH)D],和药物。我们比较了存活的患者和一年内死亡的患者的特征。
结果:入学时,在53.6%的患者中,维生素D水平低于50nmol/L,在32%中,水平≤35nmol/L死去的人可能年龄更大,男性,可能因肺炎或CHF入院,可能有较低水平的白蛋白或血红蛋白,维生素D水平较低或维生素B12水平较高,肌酐水平较高,也可能有更长的住院时间,去年住院人数增加,更多的合并症,服用≥5种药物或可能接受胰岛素治疗,利尿剂,抗精神病药,抗凝剂或苯二氮卓类药物。年龄较高,男性,入院CHF,更多的药物,低白蛋白,较高的维生素B12,维生素D<50nmol/L,抗精神病药物和抗凝剂的消费是死亡率的预测因素。
结论:维生素D缺乏症可以预测老年患者在急性老年病房住院后一年内的死亡率。但是不能推导出因果关系。然而,急性护理环境中的老年患者,因为他们的健康脆弱,应该考虑进行维生素D测试。在重症患者中,维生素D的早期干预可能改善预后.准确评估该年龄组患者的死亡率预测因子可能更具挑战性,并且需要我们研究中未包含的变量。
BACKGROUND: Mounting evidence suggests that vitamin D deficiency is associated with a higher risk of many chronic non-skeletal, age-associated diseases as well as mortality.
OBJECTIVE: To determine, in older patients aged ≥ 80, the prevalence of vitamin D deficiency and its association with comorbidity, laboratory tests, length of stay and mortality within one year from blood withdrawal on admission to acute geriatrics ward.
METHODS: We retrospectively surveyed electronic hospital health records of 830 older patients. The recorded data included patient demographics (e.g., age, sex, stay duration, readmissions number, death within one year from blood withdrawal on admission), medical diagnoses, laboratory results, including 25-hydroxyvitamin D [25(OH)D], and medications. We compared the characteristics of the patients who survived to those who died within one year.
RESULTS: On admission, in 53.6% patients, vitamin D levels were lower than 50 nmol/L, and in 32%, the levels were ≤ 35 nmol/L. Persons who died were likely to be older, of male sex, were likely to be admitted for pneumonia or CHF, were likely to have lower level of albumin or hemoglobin, lower level of vitamin D or higher vitamin B12 and higher level of creatinine, were also likely to have had a lengthier hospitalization stay, a greater number of hospitalizations in the last year, a higher number of comorbidities, to have consumption of ≥5 drugs or likely to being treated with insulin, diuretics, antipsychotics, anticoagulants or benzodiazepines. Higher age, male sex, on-admission CHF, higher number of drugs, lower albumin, higher vitamin B12, vitamin D < 50 nmol/L, and consumption of antipsychotics and anticoagulants - were predictors of mortality.
CONCLUSIONS: Hypovitaminosis D is predictive of mortality in older patients within one year from hospitalization in the acute geriatric ward, but a causal relationship cannot be deduced. Nevertheless, older patients in acute care settings, because of their health vulnerability, should be considered for vitamin D testing. In the acutely ill patients, early intervention with vitamin D might improve outcomes. Accurate evaluation of mortality predictors in this age group patients may be more challenging and require variables that were not included in our study.