Clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 TANG Rong , LIANG Jianjun

Department of Emergency, Hanzhong 3201 Hospital, Hanzhong, Shan'xi 723000, P. R. China;

Corresponding?author：

TANG Rong, Email: tangrong2017163@163.com

Keywords：

Vitamin D; 25-hydroxy vitamin D₃; Critically ill; Mechanical ventilation; Weaning failure

DOI：

10.7507/1671-6205.201711048

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ObjectiveTo investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients.MethodsA total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June 2017. Serum 25(OH)D₃ was detected on admission and before spontaneous breathing test (SBT) meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value for failure weaning.ResultsThere were 46 patients with failure weaning among 130 patients (35.38%). Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin (all P<0.05). 25(OH)D₃ level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group (P<0.05). 25(OH)D₃ levels of the failure weaning group were lower than those of the successful weaning group [on admission: (18.16±4.33) ng/ml vs. (21.60±5.25) ng/ml, P<0.05; before SBT: (13.50±3.52) ng/mlvs. (18.61±4.30) ng/ml, P<0.05]. Multivariate logistic regression analysis showed that 25(OH)D₃ levels on admission and before SBT were independent risk factors for failure weaning (OR values were 2.257 and 2.613, respectively, both P<0.05). ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%, specificities of 69.0% and 71.0%, respectively.Conclusions25(OH)D₃ deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.

Citation： TANG Rong, LIANG Jianjun. Clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 394-399. doi: 10.7507/1671-6205.201711048 Copy

1.	Rose L. Strategies for weaning from mechanical ventilation: a state of the art review. Intensive Crit Care Nurs, 2015, 31(4): 189-195.
2.	Pu L, Zhu B, Jiang L, et al. Weaning critically ill patients from mechanical ventilation: a prospective cohort study. J Crit Care, 2015, 30(4): 7-13.
3.	王燕, 袁惠敏, 張江蓉, 等. 維生素 D 缺乏對老年重癥監護患者預后的影響. 中華老年醫學雜志, 2015, 34(2): 155-158.
4.	Zhang YP, Wan YD, Sun TW, et al. Association between vitamin D deficiency and mortality in critically ill adult patients: a meta-analysis of cohort studies. Critical Care, 2014, 18(6): 684.
5.	Vosoughi N, Kashefi P, Abbasi B, et al. The relationship between Vitamin D, clinical outcomes and mortality rate in ICU patients: a prospective observational study. J Res Med Sci, 2016, 21(5): 75-80.
6.	中華醫學會重癥醫學分會. 機械通氣臨床應用指南(2006). 中華危重病急救醫學, 2007, 19(2): 65-72.
7.	Bo Z, Li Z, Li J, et al. Effect of a quality improvement program on weaning from mechanical ventilation: a cluster randomized trial. Intensive Care Med, 2015, 41(10): 1781-1790.
8.	Massey K, Dickerson RN, Brown RO. A review of vitamin D deficiency in the critical care population. Pharmacy, 2014, 2(1): 40-49.
9.	Tucker A, Ybarra J, Bingham A, et al. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards of Practice for Nutrition Support Pharmacists. Nutr Clin Pract, 2015, 30(1): 139-46.
10.	Moraes RB, Friedman G, Wawrzeniak IC, et al. Vitamin D deficiency is independently associated with mortality among critically ill patients. Clinics, 2015, 70(5): 326-332.
11.	Chen Z, Luo Z, Zhao X, et al. Association of vitamin D status of septic patients in intensive care units with altered procalcitonin levels and mortality. J Clin Endocrinol Metab, 2015, 100(2): 516-523.
12.	Quraishi SA, Mccarthy C, Blum L, et al. Plasma 25-hydroxy vitamin D levels at initiation of care and duration of mechanical ventilation in critically ill surgical patients. JPEN J Parenter Enteral Nutr, 2016, 97(2): 262-269.
13.	Amrein K, Schnedl C, Holl A, et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA, 2014, 312(15): 1520-1530.
14.	楊家來, 徐俊, 張泓. 維生素 D 對脂多糖致急性肺損傷大鼠肺組織血管緊張素轉化酶 2 和維生素 D 受體表達水平的影響. 中華急診醫學雜志, 2016, 25(12): 1284-1289.
15.	Shi Y, Liu T, Jianhua FU, et al. Vitamin D/VDR signaling attenuates lipopolysaccharide-induced acute lung injury by maintaining the integrity of the pulmonary epithelial barrier. Mol Med Rep, 2016, 13(2): 1186.
16.	Thickett DR, Moromizato T, Litonjua AA, et al. Association between prehospital vitamin D status and incident acute respiratory failure in critically ill patients: a retrospective cohort study. BMJ Open Respir Res, 2015, 2(1): e000074.
17.	Dancer R C, Parekh D, Lax S, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax, 2015, 70(7): 617-24.
18.	Scheiermann J, Klinman DM. Suppressive oligonucleotides inhibit inflammation in a murine model of mechanical ventilator induced lung injury. J Thorac Dis, 2016, 8(9): 2434-2443.
19.	楊依依, 姚尚龍, 尚游. 呼吸機相關性肺損傷發病機制研究新進展. 中華危重病急救醫學, 2016, 28(9): 861-864.
20.	Shelhamer MC, Rowan MP, Cancio LC, et al. Elevations in inflammatory cytokines are associated with poor outcomes in mechanically ventilated burn patients. J Trauma Acute Care Surg, 2015, 79(3): 431-436.
21.	Jiang M, Song JJ, Guo XL, et al. Airway humidification reduces the inflammatory response during mechanical ventilation. Respir Care, 2015, 60(12): 1720-1728.
22.	Larose TL, Brumpton BM, Langhammer A, et al. Serum 25-hydroxyvitamin D level, smoking and lung function in adults: the HUNT Study. Eur Respir J, 2015, 46(2): 355-363.
23.	Kim HJ, Jang JG, Hong KS, et al. Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia. Int J Tuberc Lung Dis, 2015, 19(6): 729-734.
24.	李山峰, 吳璟奕, 鄒雅茹,等. 氮末端腦鈉肽前體對機械通氣撤機的預測價值. 中華急診醫學雜志, 2016, 25(3): 334-337.
25.	王慧, 馬明, 陳德生, 等. 左室舒張功能不全對機械通氣撤機結果的預測價值. 中華危重病急救醫學, 2017, 29(5): 413-418.
26.	秦少博, 王春, 李萍,等. 血清 25-羥維生素 D 與左心室舒張功能. 中華老年醫學雜志, 2015, 34(5): 574-577.
27.	Hansen D, Rasmussen K, Rasmussen LM, et al. The influence of vitamin D analogs on calcification modulators, N-terminal pro-B-type natriuretic peptide and inflammatory markers in hemodialysis patients: a randomized crossover study. BMC Nephrol, 2014, 15: 130.

1. Rose L. Strategies for weaning from mechanical ventilation: a state of the art review. Intensive Crit Care Nurs, 2015, 31(4): 189-195.
2. Pu L, Zhu B, Jiang L, et al. Weaning critically ill patients from mechanical ventilation: a prospective cohort study. J Crit Care, 2015, 30(4): 7-13.
3. 王燕, 袁惠敏, 張江蓉, 等. 維生素 D 缺乏對老年重癥監護患者預后的影響. 中華老年醫學雜志, 2015, 34(2): 155-158.
4. Zhang YP, Wan YD, Sun TW, et al. Association between vitamin D deficiency and mortality in critically ill adult patients: a meta-analysis of cohort studies. Critical Care, 2014, 18(6): 684.
5. Vosoughi N, Kashefi P, Abbasi B, et al. The relationship between Vitamin D, clinical outcomes and mortality rate in ICU patients: a prospective observational study. J Res Med Sci, 2016, 21(5): 75-80.
6. 中華醫學會重癥醫學分會. 機械通氣臨床應用指南(2006). 中華危重病急救醫學, 2007, 19(2): 65-72.
7. Bo Z, Li Z, Li J, et al. Effect of a quality improvement program on weaning from mechanical ventilation: a cluster randomized trial. Intensive Care Med, 2015, 41(10): 1781-1790.
8. Massey K, Dickerson RN, Brown RO. A review of vitamin D deficiency in the critical care population. Pharmacy, 2014, 2(1): 40-49.
9. Tucker A, Ybarra J, Bingham A, et al. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards of Practice for Nutrition Support Pharmacists. Nutr Clin Pract, 2015, 30(1): 139-46.
10. Moraes RB, Friedman G, Wawrzeniak IC, et al. Vitamin D deficiency is independently associated with mortality among critically ill patients. Clinics, 2015, 70(5): 326-332.
11. Chen Z, Luo Z, Zhao X, et al. Association of vitamin D status of septic patients in intensive care units with altered procalcitonin levels and mortality. J Clin Endocrinol Metab, 2015, 100(2): 516-523.
12. Quraishi SA, Mccarthy C, Blum L, et al. Plasma 25-hydroxy vitamin D levels at initiation of care and duration of mechanical ventilation in critically ill surgical patients. JPEN J Parenter Enteral Nutr, 2016, 97(2): 262-269.
13. Amrein K, Schnedl C, Holl A, et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA, 2014, 312(15): 1520-1530.
14. 楊家來, 徐俊, 張泓. 維生素 D 對脂多糖致急性肺損傷大鼠肺組織血管緊張素轉化酶 2 和維生素 D 受體表達水平的影響. 中華急診醫學雜志, 2016, 25(12): 1284-1289.
15. Shi Y, Liu T, Jianhua FU, et al. Vitamin D/VDR signaling attenuates lipopolysaccharide-induced acute lung injury by maintaining the integrity of the pulmonary epithelial barrier. Mol Med Rep, 2016, 13(2): 1186.
16. Thickett DR, Moromizato T, Litonjua AA, et al. Association between prehospital vitamin D status and incident acute respiratory failure in critically ill patients: a retrospective cohort study. BMJ Open Respir Res, 2015, 2(1): e000074.
17. Dancer R C, Parekh D, Lax S, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax, 2015, 70(7): 617-24.
18. Scheiermann J, Klinman DM. Suppressive oligonucleotides inhibit inflammation in a murine model of mechanical ventilator induced lung injury. J Thorac Dis, 2016, 8(9): 2434-2443.
19. 楊依依, 姚尚龍, 尚游. 呼吸機相關性肺損傷發病機制研究新進展. 中華危重病急救醫學, 2016, 28(9): 861-864.
20. Shelhamer MC, Rowan MP, Cancio LC, et al. Elevations in inflammatory cytokines are associated with poor outcomes in mechanically ventilated burn patients. J Trauma Acute Care Surg, 2015, 79(3): 431-436.
21. Jiang M, Song JJ, Guo XL, et al. Airway humidification reduces the inflammatory response during mechanical ventilation. Respir Care, 2015, 60(12): 1720-1728.
22. Larose TL, Brumpton BM, Langhammer A, et al. Serum 25-hydroxyvitamin D level, smoking and lung function in adults: the HUNT Study. Eur Respir J, 2015, 46(2): 355-363.
23. Kim HJ, Jang JG, Hong KS, et al. Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia. Int J Tuberc Lung Dis, 2015, 19(6): 729-734.
24. 李山峰, 吳璟奕, 鄒雅茹,等. 氮末端腦鈉肽前體對機械通氣撤機的預測價值. 中華急診醫學雜志, 2016, 25(3): 334-337.
25. 王慧, 馬明, 陳德生, 等. 左室舒張功能不全對機械通氣撤機結果的預測價值. 中華危重病急救醫學, 2017, 29(5): 413-418.
26. 秦少博, 王春, 李萍,等. 血清 25-羥維生素 D 與左心室舒張功能. 中華老年醫學雜志, 2015, 34(5): 574-577.
27. Hansen D, Rasmussen K, Rasmussen LM, et al. The influence of vitamin D analogs on calcification modulators, N-terminal pro-B-type natriuretic peptide and inflammatory markers in hemodialysis patients: a randomized crossover study. BMC Nephrol, 2014, 15: 130.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients

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