Vitamin D supplementation during intensive care unit stay is associated with improved outcomes in critically Ill patients with sepsis: a cohort study.

IF 4.8 2区医学 Q2 IMMUNOLOGY Frontiers in Cellular and Infection Microbiology Pub Date : 2025-01-20 eCollection Date: 2024-01-01 DOI:10.3389/fcimb.2024.1485554

Caifeng Li, Ke Zhao, Qian Ren, Lin Chen, Ying Zhang, Guolin Wang, Keliang Xie

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Abstract

Background: Patients with vitamin D deficiency are susceptible to increased microbial infection and increased risk of mortality. However, whether vitamin D supplementation would improve their prognosis remains uncertain.

Methods: We conducted a retrospective cohort study using data from MIMIC-IV database, a publicly available database containing clinical information on patients admitted to the ICU at Beth Israel Deaconess Medical Center (BIDMC) from 2008 to 2019. Adult patients with sepsis were included in the analysis. The exposure factor was vitamin D supplementation during the ICU stay. The primary outcome was 28-day all-cause mortality. Both propensity score matching (PSM) and stepwise regression analyses were employed to adjust for potential confounders.

Results: A total of 20230 eligible patients were enrolled in the entire unmatched cohort, and 8710 patients were included in the matched cohort. In PSM analysis, the 28-day all-cause mortality rate was 14.04% (250/1780) in the vitamin D group and 22.31% (1546/6930) in the no vitamin D group. Vitamin D supplementation was associated with decreased 28-day all-cause mortality (HR, 0.56; 95% CI, 0.49-0.64; p < 0.001). Subgroup analyses showed consistent benefits regardless of the baseline vitamin D status (deficiency: HR, 0.70; 95% CI, 0.33-1.50; p = 0.36; insufficiency: HR, 0.10; 95% CI, 0.03-0.34; p < 0.001; sufficiency: HR, 0.33; 95% CI, 0.12-0.88; p = 0.03). Additionally, vitamin D supplementation was associated with decreased ICU mortality (OR, 0.37; 95% CI, 0.29-0.48; p < 0.001) and reduced in-hospital mortality (OR, 0.57; 95% CI, 0.48-0.68; p < 0.001). Sensitivity analysis using the unmatched cohort confirmed these findings (HR, 0.57; 95% CI, 0.43-0.76; p < 0.001).

Conclusions: Vitamin D supplementation may reduce mortality in critically ill patients with sepsis. However, further high-quality prospective studies are still needed to validate these findings.

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重症监护病房住院期间补充维生素D与脓毒症危重患者预后改善相关：一项队列研究

背景：维生素D缺乏症患者易患微生物感染和死亡风险增加。然而，补充维生素D是否会改善其预后仍不确定。方法：我们使用MIMIC-IV数据库的数据进行了一项回顾性队列研究，该数据库是一个公开的数据库，包含2008年至2019年贝斯以色列女执事医疗中心（BIDMC） ICU住院患者的临床信息。成人脓毒症患者也被纳入分析。暴露因素是在ICU住院期间补充维生素D。主要终点为28天全因死亡率。采用倾向得分匹配（PSM）和逐步回归分析来调整潜在的混杂因素。结果：整个非匹配队列共纳入20230例符合条件的患者，匹配队列纳入8710例患者。在PSM分析中，维生素D组28天全因死亡率为14.04%(250/1780)，无维生素D组为22.31%（1546/6930）。补充维生素D与降低28天全因死亡率相关(HR, 0.56；95% ci, 0.49-0.64；P < 0.001)。亚组分析显示，无论基线维生素D状态如何(缺乏：HR， 0.70；95% ci, 0.33-1.50；P = 0.36；不足：HR， 0.10；95% ci, 0.03-0.34；P < 0.001；充分性：HR， 0.33；95% ci, 0.12-0.88；P = 0.03)。此外，补充维生素D与降低ICU死亡率相关(OR, 0.37；95% ci, 0.29-0.48；p < 0.001)并降低住院死亡率(OR, 0.57；95% ci, 0.48-0.68；P < 0.001)。使用未匹配队列进行敏感性分析证实了这些发现(HR, 0.57；95% ci, 0.43-0.76；P < 0.001)。结论：补充维生素D可降低重症脓毒症患者的死亡率。然而，仍需要进一步的高质量前瞻性研究来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Cellular and Infection Microbiology IMMUNOLOGY-MICROBIOLOGY

CiteScore

7.90

自引率

7.00%

发文量

1817

审稿时长

14 weeks

期刊介绍： Frontiers in Cellular and Infection Microbiology is a leading specialty journal, publishing rigorously peer-reviewed research across all pathogenic microorganisms and their interaction with their hosts. Chief Editor Yousef Abu Kwaik, University of Louisville is supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Cellular and Infection Microbiology includes research on bacteria, fungi, parasites, viruses, endosymbionts, prions and all microbial pathogens as well as the microbiota and its effect on health and disease in various hosts. The research approaches include molecular microbiology, cellular microbiology, gene regulation, proteomics, signal transduction, pathogenic evolution, genomics, structural biology, and virulence factors as well as model hosts. Areas of research to counteract infectious agents by the host include the host innate and adaptive immune responses as well as metabolic restrictions to various pathogenic microorganisms, vaccine design and development against various pathogenic microorganisms, and the mechanisms of antibiotic resistance and its countermeasures.