Score-based prediction model for severe vitamin D deficiency in patients with critical illness: development and validation

Abstract

Background Severe vitamin D deficiency (SVDD) dramatically increases the risks of mortality, infections, and many other diseases. Studies have reported higher prevalence of vitamin D deficiency in patients with critical illness than general population. This multicenter retrospective cohort study develops and validates a score-based model for predicting SVDD in patients with critical illness. Methods A total of 662 patients with critical illness were enrolled between October 2017 and July 2020. SVDD was defined as a serum 25(OH)D level of < 12 ng/mL (or 30 nmol/L). The data were divided into a derivation cohort and a validation cohort on the basis of date of enrollment. Multivariable logistic regression (MLR) was performed on the derivation cohort to generate a predictive model for SVDD. Additionally, a score-based calculator (the SVDD score) was designed on the basis of the MLR model. The model’s performance and calibration were tested using the validation cohort. Results The prevalence of SVDD was 16.3% and 21.7% in the derivation and validation cohorts, respectively. The MLR model consisted of eight predictors that were then included in the SVDD score. The SVDD score had an area under the receiver operating characteristic curve of 0.848 [95% confidence interval (CI) 0.781–0.914] and an area under the precision recall curve of 0.619 (95% CI 0.577–0.669) in the validation cohort. Conclusions This study developed a simple score-based model for predicting SVDD in patients with critical illness. Trial registration: ClinicalTrials.gov protocol registration ID: NCT03639584. Date of registration: May 12, 2022. Graphical Abstract

Métodos de avaliação de fluido responsividade: revisão de literatura

“…Os métodos estáticos buscam avaliar o estado volêmico por medidas indiretas da pré-carga cardíaca. Contudo, esses métodos de avaliação não conseguem predizer com confiança a responsividade ao volume, devido ao fato que a complacência cardíaca poder variar com as patologias de cada paciente e com o estado de choque circulatório [5,6]. Além disso, outro fator que prejudica a confiabilidade dos métodos estáticos se deve à dependência e influência das pressões pleurais sob o coração, sendo um fator de confusão da análise [5,6].…”

“…Sendo assim, o uso de fluidos intravenosos para melhorar a oferta de O2 para os tecidos deve ser realizada com cautela, pois estes fluidos são medicamentos e o seu uso de forma desorientada pode piorar o desfecho clínico. Estudos recentes têm demonstrado aumento na mortalidade, insuficiência renal aguda (IRA) e outra complicações relacionadas ao uso inadequado de fluidos em pacientes graves [4,5].…”

Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?

“…Many observational studies emphasize the association between 25(OH)D levels and cardiovascular disease, atherosclerosis, hypertension and heart disease in CKD patients and the elderly [ 145 ]. Vitamin D deficiency was an independent predictor of mortality in patients with or without heart failure [ 146 , 147 , 148 , 149 ]. It was suggested that seasonal fluctuations in mortality (i.e., decreased CVD-related deaths in the summer and increased deaths in the winter) might be related to the lower vitamin D levels in the blood during winter [ 150 ].…”