Effect of vitamin D deficiency in Korean patients with acute respiratory distress syndrome
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Vitamin D modulates innate and adaptive immune responses, and vitamin D deficiency is associated with increased mortality in hospitalized patients with pneumonia. We evaluated the prevalence of vitamin D deficiency in Korean patients with acute respiratory distress syndrome (ARDS) and its effect on the clinical outcomes of ARDS. Methods: We retrospectively analyzed the data of 108 patients who had a measured serum level of 25-hydroxy vitamin D3 (25(OH)D3) at the time of diagnosis with ARDS. The clinical outcomes were evaluated based on 25(OH)D3 levels of 20 ng/mL and stratified by quartiles of 25(OH)D3 levels. Results: The mean age of patients was 59.4 years old; 77 (71.3%) were male. Vitamin D deficiency was found in 103 patients (95.4%). The mean 25(OH)D3 level was 8.3 ± 7.0 ng/mL. Neither in-hospital mortality (40.0% vs. 68.0%) nor 6-month mortality (40.0% vs. 71.8%) significantly differed between groups. There were no significant differences in 25(OH)D3 level between survivors (8.1 ± 7.6 ng/mL) and non-survivors (8.5 ± 6.8 ng/mL, p = 0.765). There were no trends toward a difference in mortality among quartiles of 25(OH)D3 levels. However, 25(OH)D3 levels were inversely related with length of hospital stay and intensive care unit stay among in-hospital survivors. Conclusions: Vitamin D deficiency was prevalent in Korean patients with ARDS. However, levels of vitamin D were not associated with mortality. A large, prospective study is needed to evaluate the effects of vitamin D deficiency on clinical outcomes of ARDS.
Abstract
Background/Aims: Vitamin D modulates innate and adaptive immune responses, and vitamin D deficiency is associated with increased mortality in hospitalized patients with pneumonia. We evaluated the prevalence of vitamin D deficiency in Korean patients with acute respiratory distress syndrome (ARDS) and its effect on the clinical outcomes of ARDS. Methods: We retrospectively analyzed the data of 108 patients who had a measured serum level of 25-hydroxy vitamin D3 (25(OH)D3) at the time of diagnosis with ARDS. The clinical outcomes were evaluated based on 25(OH)D3 levels of 20 ng/mL and stratified by quartiles of 25(OH)D3 levels. Results: The mean age of patients was 59.4 years old; 77 (71.3%) were male. Vitamin D deficiency was found in 103 patients (95.4%). The mean 25(OH)D3 level was 8.3 ± 7.0 ng/mL. Neither in-hospital mortality (40.0% vs. 68.0%) nor 6-month mortality (40.0% vs. 71.8%) significantly differed between groups. There were no significant differences in 25(OH)D3 level between survivors (8.1 ± 7.6 ng/mL) and non-survivors (8.5 ± 6.8 ng/mL, p = 0.765). There were no trends toward a difference in mortality among quartiles of 25(OH)D3 levels. However, 25(OH)D3 levels were inversely related with length of hospital stay and intensive care unit stay among in-hospital survivors. Conclusions: Vitamin D deficiency was prevalent in Korean patients with ARDS. However, levels of vitamin D were not associated with mortality. A large, prospective study is needed to evaluate the effects of vitamin D deficiency on clinical outcomes of ARDS.
참고문헌 (32)
- Rubenfeld GD, "Incidence and outcomes of acute lung injury", N Engl J Med, 353, pp.1685~1693 (2005)
- Bone RC, "An early test of survival in patients with the adult respiratory distress syndrome. The PaO2", FIo2 ratio and its differential response to conventional therapy. Prostaglandin E1 Study Group, 1989, pp.96, 849~851
- Nin N, "Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome", Intensive Care Med, 43, pp.200~208 (2017)
- Stapleton RD, "Causes and timing of death in patients with ARDS", Chest, 128, pp.525~532 (2005)
- Doyle RL, "Identification of patients with acute lung injury. Predictors of mortality", Am J Respir Crit Care Med, 152(6 Pt 1), pp.1818~1824 (1995)
- Bone RC, "Adult respiratory distress syndrome. Sequence and importance of development of multiple organ failure. The Prostaglandin E1Study Group", Chest, 101, pp.320~326 (1992)
- Rosenberg AL, "Review of a large clinical series:association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort", J Intensive Care Med, 24, pp.35~46 (2009)
- Choi HS, "Vitamin D insufficiency in Korea: a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES)2008", J Clin Endocrinol Metab, 96, pp.643~651 (2011)
- Barragan M, "Regulation of dendritic cell function by vitamin D", Nutrients, 7, pp.8127~8151 (2015)
- Berraies A, "Link between vitamin D and airway remodeling", J Asthma Allergy, 7, pp.23~30 (2014)
- Mirzakhani H, "Vitamin D and the development of allergic disease: how important is it?", Clin Exp Allergy, 45, pp.114~125 (2015)
- Parker J, "Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis", Maturitas, 65, pp.225~236 (2010)
- Hong Q, "Associations between serum 25-hydroxyvitamin D and disease activity, inflammatory cytokines and bone loss in patients with rheumatoid arthritis", Rheumatology (Oxford), 53, pp.1994~2001 (2014)
- Yawn J, "Vitamin D for the treatment of respiratory diseases: is it the end or just the beginning?", J Steroid Biochem Mol Biol, 148, pp.326~337 (2015)
- Kerley CP, "Vitamin D as an adjunctive therapy in asthma. Part 2: a review of human studies", Pulm Pharmacol Ther, 32, pp.75~92 (2015)
- Ananthakrishnan AN, "Association between reduced plasma 25-hydroxy vitamin D and increased risk of cancer in patients with inflammatory bowel diseases", Clin Gastroenterol Hepatol, 12, pp.821~827 (2014)
- Leow L, "Vitamin D, innate immunity and outcomes in community acquired pneumonia", Respirology, 16, pp.611~616 (2011)
- Holter JC, "Vitamin D status and long-term mortality in community-acquired pneumonia:secondary data analysis from a prospective cohort", PLoS One, 11, pp.e0158536~ (2016)
- de Haan K, "Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis", Crit Care, 18, pp.660~ (2014)
- Moromizato T, "Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill", Crit Care Med, 42, pp.97~107 (2014)
- Dancer RC, "Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS)", Thorax, 70, pp.617~624 (2015)
- ARDS Definition Task Force, "Acute respiratory distress syndrome: the Berlin definition", JAMA, 307, pp.2526~2533 (2012)
- Holick MF, "Evaluation, treatment, and prevention of vitamin D deficiency:an Endocrine Society Clinical Practice Guideline", J Clin Endocrinol Metab, 96, pp.1911~1930 (2011)
- Darmon M, "Acute respiratory distress syndrome and risk of AKI among critically ill patients", Clin J Am Soc Nephrol, 9, pp.1347~1353 (2014)
- Caser EB, "Impact of distinct definitions of acute lung injury on its incidence and outcomes in Brazilian ICUs: prospective evaluation of 7,133 patients*", Crit Care Med, 42, pp.574~582 (2014)
- Seeley E, "Predictors of mortality in acute lung injury during the era of lung protective ventilation", Thorax, 63, pp.994~998 (2008)
- Villar J, "The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation", Intensive Care Med, 37, pp.1932~1941 (2011)
- Yu S, "Role of diabetes in the development of acute respiratory distress syndrome", Crit Care Med, 41, pp.2720~2732 (2013)
- Gong MN, "Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion", Crit Care Med, 33, pp.1191~1198 (2005)
- Remmelts HH, "Addition of vitamin D status to prognostic scores improves the prediction of outcome in community-acquired pneumonia", Clin Infect Dis, 55, pp.1488~1494 (2012)
- Kim HJ, "Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia", Int J Tuberc Lung Dis, 19, pp.729~734 (2015)
- Kankova M, "Impairment of cytokine production in mice fed a vitamin D3-deficient diet", Immunology, 73, pp.466~471 (1991)