血清25-羟维生素D与急诊病房卒中相关性肺炎发生及预后的相关性

doi:10.3969/j.issn.1006-9771.2023.10.014

Abstract

Abstract:

Objective To investigate the association between serum 25-hydroxy vitamin D [25(OH)D] and the occurrence and outcome of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) in emergency ward.
Methods The clinical data of 256 patients with AIS from January, 2019 to December, 2021 were collected in the emergency department of Beijing Bo'ai Hospital. Blood routine, biochemical indicators and serum concentration of 25(OH)D were detected within 24 hours after enrollment; meanwhile, National Institute of Health Stroke Scale (NIHSS) and A2DS2 score were evaluated. The patients were divided into non-SAP group (n = 164) and SAP group (n = 92) according to whether pneumonia occurred during hospitalization. Multivariable logistic regression model was used to analyze the influencing factors of SAP. The predictive ability of serum 25(OH)D and A2DS2 for SAP were evaluated by receiver operating characteristic (ROC) curves. The 28-day survival of patients with SAP was followed up. Multivariable Cox proportional hazard regression model was used to investigate the association between vitamin D nutritional status and 28-day all-cause mortality.
Results Serum 25(OH)D was significantly lower in the SAP group than that in the non-SAP group (Z = 6.896, P < 0.001). After adjusting age, sex, infarct volume, A2DS2 score and other factors, lower serum 25(OH)D level (OR = 0.934, 95%CI 0.884 to 0.986, P = 0.014) was an independent risk factor for SAP. The areas under curve (95%CI) of serum 25(OH)D, A2DS2 score and their combined model for predicting SAP were 0.774 (0.718 to 0.824), 0.832 (0.781 to 0.876) and 0.851 (0.802 to 0.893) (P < 0.001), respectively; and the optimum cut-off values were 25(OH)D < 10.2 ng/mL, A2DS2 score > 5 points, combined prediction > 0.207, and the Youden index were 0.493, 0.662 and 0.616, respectively. A2DS2 score could improve the prediction efficiency of serum 25(OH)D (Z = 2.106, P = 0.035). After adjusting age, sex, infarct volume and NIHSS score, vitamin D deficiency was an independent risk factor for all-cause mortality after 28 days of SAP (HR = 2.871, 95%CI 1.004 to 8.208, P = 0.049).
Conclusion Serum 25(OH)D is independently associated with the occurrence and outcome of SAP in patients with AIS in emergency ward, which could serve as an independent predictor for SAP.

Key words: stroke, stroke-associated pneumonia, 25-hydroxy vitamin D, outcome

CLC Number:

R743.3

LIU Huizhen, SHANG Na, LI Junyu, WANG Na, LI Fang, LIU Xiaomeng, GUO Shubin. Association of serum 25-hydroxy vitamin D with the occurrence and outcome of stroke-associated pneumonia in patients in emergency ward[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1214-1220.

Figures/Tables 6

References 36

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变量	SAP组 (n = 92)	非SAP组 (n = 164)	Z/χ²/t值	P值
年龄/岁	82.0 (71.5, 87.0)	65.0 (56.0, 79.0)	6.913	< 0.001
女性/n	52	54	13.524	< 0.001
BMI/(kg·m^-2)	23.72±4.58	25.13±3.36	2.444	0.016
高血压/n	65	103	1.609	0.205
糖尿病/n	35	69	0.397	0.529
房颤/n	26	21	9.393	0.002
梗死体积/cm³	8.50 (0.97, 43.20)	1.04 (0.35, 4.60)	5.390	< 0.001
A2DS2评分	7.0 (5.0, 8.0)	4.0 (3.0, 5.5)	8.379	< 0.001
WBC/(10⁹·L^-1)	8.26±2.56	7.31±2.33	2.856	0.005
ALB/(g·L^-1)	35.85±4.88	40.16±4.04	6.046	< 0.001
HCY/(μmol·L^-1)	16.0 (12.3, 23.8)	14.4 (10.9, 20.9)	1.466	0.143
尿酸/(μmol·L^-1)	334 (248, 403)	330 (281, 409)	0.411	0.681
hs-CRP/(mg·L^-1)	14.40 (2.50, 39.60)	2.10 (1.10, 4.10)	5.502	< 0.001
25(OH)D/(ng·mL^-1)	9.4 (5.5, 14.0)	15.2 (10.3, 22.6)	6.896	< 0.001

变量	B值	S.E.	Wald值	df	P值	OR值	95%CI
年龄	0.048	0.016	8.923	1	0.003	1.049	1.017~1.083
性别
男性(参照)	0.000					1.000
女性	0.584	0.400	2.128	1	0.145	1.793	0.818~3.930
梗死体积	0.017	0.011	2.314	1	0.128	1.017	0.995~1.039
A2DS2评分	0.150	0.113	4.862	1	0.027	1.162	1.008~1.503
hs-CRP	0.258	0.081	10.129	1	0.001	1.294	1.104~1.517
25(OH)D	-0.069	0.028	6.026	1	0.014	0.934	0.884~0.986
常数	-4.465	1.266	12.444	1	< 0.001	0.012

变量	AUC(95%CI)	截断值	YI	敏感性	特异性	Z值	P值
25(OH)D	0.774(0.718~0.824)	< 10.2 ng/mL	0.493	0.781	0.712	7.076	< 0.001
A2DS2评分	0.832(0.781~0.876)	> 5.0 分	0.662	0.829	0.833	8.102	< 0.001
联合变量	0.851(0.802~0.893)	> 0.207	0.616	0.775	0.841	10.714	< 0.001

变量	B值	S.E.	Wald值	df	P值	HR值	95%CI
年龄	0.074	0.038	3.694	1	0.055	1.076	0.999~1.160
性别
男性(参照)	0.000					1.000
女性	0.216	0.983	0.048	1	0.826	1.241	0.181~8.524
梗死体积	0.005	0.005	1.195	1	0.274	1.005	0.995~1.014
维生素D缺乏
无(参照)	0.000					1.000
有	1.055	0.536	3.872	1	0.049	2.871	1.004~8.208
NIHSS评分	0.106	0.044	5.875	1	0.015	1.112	1.020~1.211

Association of serum 25-hydroxy vitamin D with the occurrence and outcome of stroke-associated pneumonia in patients in emergency ward

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