Association of serum 25 hydroxy-vitamin D with short-term prognosis in elderly patients in emergency care settings / 中华急诊医学杂志

ABSTRACT

Objective:To explore the association of Vitamin D (Vit D) nutritional status and prognosis in elderly patients in emergency care settings.Methods:The clinical data of 317 elderly patients admitted in the Emergency Care Unit and Emergency Observation Ward of Beijing Bo'Ai hospital from January 2021 to September 2021 were collected continuously. Blood routine, biochemical indicators, serum interleukin-6 (IL-6), thyroid-stimulating hornone (TSH), cortisol (COR) and 25-hydroxyvitamin D [25(OH)D] levels were detected within 24 hours after enrollment. Patients were divided into severe vitamin D deficiency group and non-severe vitamin D deficiency group according to the level of serum 25(OH)D. Patients were followed up for the treatment with machinery ventilation during hospitalization and 28-day all-cause mortality. Multivariable logistic regression model was used to analyze the association between the Vit D nutritional status and machinery ventilation. In order to evaluate the predictive ability of serum 25(OH)D for the requirement of machinery ventilation, the receiver operating characteristic (ROC) curve was applied and the area under the ROC curve (95% confidence interval) [AUC (95% CI)] was calculated. Cox proportional hazards regression model was used to analyze the association between Vit D nutritional status and 28-day all-cause mortality. Results:Serum 25(OH) level in the machinery ventilation group was significantly lower than that in the non-mechanical ventilation group ( Z = 5.150, P < 0.001). Multivariable logistic regression analysis showed that severe Vit D deficiency ( OR = 7.223, 95% CI 1.546-33.742, P = 0.012) was independently associated with machinery ventilation. The AUC (95% CI) of serum 25(OH)D for predicting machinery ventilation was 0.825 (0.770-0.871) ( P < 0.001), the predictive cut-off point was 11.0 μg/L, and the Youden index was 0.580, yielding a sensitivity of 0.903 and a specificity of 0.677. Cox regression analysis showed that severe Vit D deficiency ( HR = 2.403, 95% CI 1.133-5.096, P = 0.022) was an independent predictor of 28-day all-cause mortality in elderly emergency patients. Conclusions:Serum 25(OH)D can be used as an independent predictor of short-term prognosis in elderly emergency patients.