Intervention of vitamin D on acute respiratory distress syndrome caused by septic shock

doi:10.3877/cma.j.issn.1674-6880.2020.05.001

Abstract

Abstract:

Objective

To explore the intervention effect of vitamin D on acute respiratory distress syndrome (ARDS) patients caused by septic shock.

Methods

From June 2017 to June 2019, 80 ARDS patients with septic shock in the Intensive Care Unit of the First Hospital of Shanxi Medical University were selected. Based on the 25-hydroxyvitamin D level, they were classified into a normal vitamin D group (17 patients, 25-hydroxyvitamin D ≥ 50 nmol/L) and a vitamin D reduction group (63 patients, 25-hydroxyvitamin D < 50 nmol/L). Then according to the decreased level of 25-hydroxyvitamin D, patients in the vitamin D reduction group were further divided into a vitamin D deficiency group (35 patients, 30 nmol/L ≤ 25-hydroxyvitamin D ≤ 49.9 nmol/L) and a severe vitamin D deficiency group (28 patients, 25-hydroxyvitamin D < 30 nmol/L). Using a random number table method, patients in the vitamin D deficiency group were divided into an A group (control group, 17 patients) and a B group (intervention group, 18 patients), and patients in the severe vitamin D deficiency group were divided into a C group (control group, 14 patients) and a D group (intervention group, 14 patients). Patients in the A and C groups were given 0.5 g/d starch capsule through the stomach tube and enteral nutrition tube, while patients in the B and D groups were given 0.5 g/d alfacalcidol soft capsule through the nasogastric tube and nasointestinal tube, all for 7 days. The age, sex, 25-hydroxyvitamin D, oxygenation index, acute physiology and chronic health evaluation (APACHE) Ⅱ score, extra vascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and 28-d mortality of all patients were recorded, and risk factors influencing 28-d mortality of ARDS patients with septic shock were analyzed by Cox regression analysis.

Results

The 25-hydroxyvitamin D [(57 ± 4) nmol/L vs. (33 ± 8) nmol/L], oxygenation index [(135 ± 25) mmHg vs. (114 ± 18) mmHg], APACHE Ⅱ score [(14.7 ± 1.6) scores vs. (16.0 ± 2.0) scores], EVLWI [(11.4 ± 2.1) mL/kg vs. (14.5 ± 2.7) mL/kg], PVPI [(3.61 ± 0.32) vs. (5.05 ± 0.68)] and 28-d mortality (1/17 vs. 20/63) were statistically significantly different betwwen the normal vitamin D group and vitamin D reduction group (t = 11.448, 3.872, 8.864, 5.097, 8.409; χ² = 4.626; all P < 0.05). Cox regression analysis showed that the 25-hydroxyvitamin D [relative risk = 4.183, 95% confidence interval (1.787, 10.594), P = 0.012] was a protective factor for the prognosis of ARDS patients with septic shock. After the intervention, the 25-hydroxyvitamin D [(25 ± 4) nmol/L vs. (37 ± 4) nmol/L], oxygenation index [(152 ± 18) mmHg vs. (171 ± 13) mmHg], APACHE Ⅱ score [(12.8 ± 1.4) scores vs. (11.0 ± 1.7) scores], EVLWI [(9.5 ± 0.9) mL/kg vs. (7.9 ± 1.4) mL/kg] and PVPI [(3.63 ± 0.28) vs. (2.95 ± 0.48)] were statistically significantly different between the C and D groups (t = 7.493, 3.246, 3.016, 3.420, 4.373; all P < 0.05), while the 28-d mortality was not statistically significantly different (6/14 vs. 4/14, χ² = 0.622, P = 0.430).

Conclusions

The decrease of vitamin D is common in ARDS patients caused by septic shock, and vitamin D is a protective factor for their 28-d mortality. The supplementation of vitamin D may improve the severity of ARDS in patients with severe vitamin D deficiency.

Key words: Vitamin D, Shock, septic, Acute respiratory distress syndrome, 25-hydroxyvitamin D

Na Li, Meixia Wang, Jinmeng Zhou, Hong Liu, Lan Zhao, Zhefang Yao, Xuehui Wang. Intervention of vitamin D on acute respiratory distress syndrome caused by septic shock[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(05): 321-327.

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组别	例数	年龄（岁）	性别（例，男/女）	25-羟维生素D（nmol/L）	氧合指数（mmHg）	APACHEⅡ评分（分）	EVLWI（mL/kg）	PVPI
维生素D正常组	17	61 ± 11	12/5	57 ± 4	135 ± 25	14.7 ± 1.6	11.4 ± 2.1	3.61 ± 0.32
维生素D降低组	63	62 ± 11	41/22	33 ± 8	114 ± 18	16.0 ± 2.0	14.5 ± 2.7	5.05 ± 0.68
t/χ²值		0.388	0.182	11.448	3.872	8.864	5.097	8.409
P值		0.699	0.690	< 0.001	0.004	< 0.001	< 0.001	< 0.001

组别	例数	年龄（岁）	性别（例，男/女）	25-羟维生素D（nmol/L）	氧合指数（mmHg）	APACHEⅡ评分（分）	EVLWI（mL/kg）	PVPI
维生素D正常组	17	61 ± 11	12/5	57 ± 4	135 ± 25	14.7 ± 1.6	11.4 ± 2.1	3.61 ± 0.32
维生素D降低组	63	62 ± 11	41/22	33 ± 8	114 ± 18	16.0 ± 2.0	14.5 ± 2.7	5.05 ± 0.68
t/χ²值		0.388	0.182	11.448	3.872	8.864	5.097	8.409
P值		0.699	0.690	< 0.001	0.004	< 0.001	< 0.001	< 0.001

影响因素	回归系数	标准误	Wald值	P值	RR值	95%CI
25-羟维生素D（nmol/L）	-0.082	0.532	7.428	0.012	4.183	1.787 ~ 10.594
氧合指数（mmHg）	0.874	0.282	9.406	0.001	1.430	0.371 ~ 1.824
APACHEⅡ评分（分）	1.929	0.636	10.142	0.001	7.220	2.153 ~ 23.994
EVLWI（mL/kg）	1.828	0.536	10.024	0.001	7.102	2.134 ~ 20.499
PVPI	0.865	0.187	10.941	0.001	1.502	1.265 ~ 2.501

影响因素	回归系数	标准误	Wald值	P值	RR值	95%CI
25-羟维生素D（nmol/L）	-0.082	0.532	7.428	0.012	4.183	1.787 ~ 10.594
氧合指数（mmHg）	0.874	0.282	9.406	0.001	1.430	0.371 ~ 1.824
APACHEⅡ评分（分）	1.929	0.636	10.142	0.001	7.220	2.153 ~ 23.994
EVLWI（mL/kg）	1.828	0.536	10.024	0.001	7.102	2.134 ~ 20.499
PVPI	0.865	0.187	10.941	0.001	1.502	1.265 ~ 2.501

组别		例数	25-羟维生素D（nmol/L）	氧合指数（mmHg）	APACHEⅡ评分（分）	EVLWI（mL/kg）	PVPI
A组
	干预前	17	38 ± 5	127 ± 22	16.2 ± 2.5	13.8 ± 3.4	4.14 ± 0.51
	干预后	17	39 ± 5	165 ± 25	12.2 ± 1.9	9.2 ± 1.9	3.31 ± 0.42
B组
	干预前	18	39 ± 4	121 ± 14	15.6 ± 1.8	12.5 ± 2.1	4.25 ± 0.37
	干预后	18	47 ± 9^a	177 ± 28	11.6 ± 1.6	8.7 ± 2.0	2.88 ± 0.54

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