维生素D水平与重症患者医院获得性压疮发生有相关性

　　医院获得性压疮（HAPU）在ICU患者中较为常见，是导致患者死亡的重要诱因。目前，临床上有效预防压疮的手段有限。有研究表明患者的营养状况在其中扮演重要角色；维生素D有助于改善免疫，维持肌肉、骨骼、上皮细胞的完整性及功能，促进伤口愈合。

　　为了探讨维生素D与院内压疮形成的关系，美国麻省总医院、加利福尼亚大学对402例成年外科重症患者进行了回顾分析。

　　结果发现，25-羟维生素D（25-OHD）平均水平为18ng/ml，HAPU发生率占11%（n=44）；25-OHD每升高一个单位，HAPU的发生风险降低11%。此外，低25-OHD水平（＜20ng/ml）患者比高水平患者（≥20ng/mL）HAPU的发生风险高出2倍以上（比值比：2.51，95%置信区间：1.06～5.97）。

　　因此，该研究表明，外科重症患者的维生素D水平与压疮发生有高度相关性。

JPEN J Parenter Enteral Nutr. 2017;41(2):289.

Vitamin D status is associated with the development of hospital-acquired pressure ulcers in critically ill surgical patients.

Tiffany Otero; Cecilia Canales; D. Dante Yeh; Donna M. Belcher; Sadeq A. Quraishi.

Massachusetts General Hospital, Boston, Massachusetts, USA; University of California-Irvine, Irvine, California, USA.

Purpose: Pressure ulcers are a significant source of morbidity and mortality in hospitalized patients. Critically ill patients are particularly at risk for developing pressure ulcers due to factors such as prolonged immobility, impaired immune function, and medical comorbidities. Although pressure ulcer development is considered an important metric for the quality of hospital-based care, effective strategies for the prevention of pressure ulcers are limited. A growing body of evidence suggests that nutrition status may be a modifiable risk factor for the development of pressure ulcers. In particular, vitamin D has been shown to play a central role in promoting musculoskeletal health, optimizing immune function, sustaining epithelial cell integrity, and supporting tissue healing. However, few studies have explored the role of vitamin D for the prevention of pressure ulcers. Therefore, our goal was to investigate the association of admission vitamin D status with the development of subsequent pressure ulcers in critically ill surgical patients.

Methods: We performed a retrospective analysis of data from a prospective, observational study of nutrition status in critically ill surgical patients. All patients had 25-hydroxyvitamin D levels (25OHD) measured within 24 hours of intensive care unit (ICU) admission. A hospital-acquired pressure ulcer (HAPU) was identified as any newly documented pressure ulcer during the course of hospitalization. Patients with documented pressure ulcers at the time of ICU admission were excluded. To investigate the association of vitamin D status with the development of HAPU, we performed a logistic regression analysis, while controlling for body mass index (BMI), Nutrition Risk in the Critically Ill (NUTRIC) score, ICU length of stay (LOS), and either cumulative protein or caloric deficit during ICU admission. For our primary regression model, vitamin D status was treated as a continuous variable. Since vitamin D adequacy has been defined conservatively as 25OHD levels ≥20 ng/mL, we repeated the regression analysis, while considering vitamin D status as a dichotomous variable (ie, 25OHD <20 ng/mL vs ≥20 ng/mL).

Results: In total, 402 adult surgical ICU patients comprised the analytic cohort. Mean 25OHD was 18 (SD 8) ng/mL, and the incidence of HAPU was 11% (n = 44). When vitamin D status was considered as a continuous variable, logistical regression analysis (controlling for BMI, NUTRIC score, ICU LOS, and cumulative protein deficit) demonstrated that each unit increment in 25OHD was associated with an 11% reduction in the risk of HAPU (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84-0.95). When vitamin D status was dichotomized in the same model, patients with 25OHD <20 ng/mL were more than twice as likely to develop HAPU (OR, 2.51; 95% CI, 1.06-5.97), compared with those with levels ≥20 ng/mL. In both models, substituting caloric deficit for protein deficit did not materially affect the results (OR, 0.89; 95% CI, 0.84-0.95 and OR, 2.60; 95% CI, 1.11-6.09, respectively).

Conclusions: Our data suggest that in critically ill surgical patients, vitamin D status on ICU admission is strongly linked to the development of subsequent pressure ulcers. Randomized, controlled trials are needed to determine whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPU and improve overall patient outcomes.

Financial support: Funding provided by National Center for Advancing Translational Science, National Institutes of Health, Award Number TL1 TR001062 (TMNO) and L30 TR001257 (SAQ).

DOI: 10.1177/0148607116686023