Data Sheet 1_Vitamin D supplementation during intensive care unit stay is associated with improved outcomes in critically Ill patients with sepsis: a cohort study.pdf

BackgroundPatients 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.
MethodsWe 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.
ResultsA 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).
ConclusionsVitamin D supplementation may reduce mortality in critically ill patients with sepsis. However, further high-quality prospective studies are still needed to validate these findings.

研究背景：维生素D缺乏症患者更易发生微生物感染，且死亡风险升高。然而，补充维生素D是否能改善此类患者的预后仍不明确。
研究方法：本研究采用公开的MIMIC-IV数据库数据开展回顾性队列研究，该数据库收录了2008年至2019年于贝丝以色列女执事医疗中心（BIDMC）重症监护病房（Intensive Care Unit，ICU）收治患者的临床信息。本研究纳入成年脓毒症患者进行分析，暴露因素为患者ICU住院期间的维生素D补充行为，主要结局指标为28天全因死亡率。本研究采用倾向得分匹配（propensity score matching）及逐步回归分析对潜在混杂因素进行校正。
研究结果：本研究共纳入20230例符合纳入标准的患者进入完整的未匹配队列，其中8710例患者进入匹配队列。在倾向得分匹配分析中，维生素D补充组的28天全因死亡率为14.04%（250/1780），未补充组为22.31%（1546/6930）。维生素D补充与28天全因死亡率降低相关（风险比（Hazard Ratio，HR）=0.56；95%置信区间（Confidence Interval，CI）=0.49~0.64；P<0.001）。亚组分析显示，无论患者基线维生素D状态如何，补充维生素D均能带来一致的获益：维生素D缺乏亚组（HR=0.70；95%CI=0.33~1.50；P=0.36）、维生素D不足亚组（HR=0.10；95%CI=0.03~0.34；P<0.001）及维生素D充足亚组（HR=0.33；95%CI=0.12~0.88；P=0.03）。此外，维生素D补充还与ICU死亡率降低（比值比（Odds Ratio，OR）=0.37；95%CI=0.29~0.48；P<0.001）及住院死亡率降低（OR=0.57；95%CI=0.48~0.68；P<0.001）相关。采用未匹配队列进行的敏感性分析验证了上述结果（HR=0.57；95%CI=0.43~0.76；P<0.001）。
研究结论：维生素D补充或可降低脓毒症重症患者的死亡率，但仍需开展高质量的前瞻性研究以验证本研究结果。