{"title":"危重病人补充维生素D：荟萃分析。","authors":"Wen-He Zheng, Jia-Heng Shi, Da-Xing Yu, Hui-Bin Huang","doi":"10.3389/fnut.2025.1505616","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Vitamin D is commonly used in clinical practice, while its clinical significance in critically ill patients remains controversial. Therefore, we aimed to perform a systemic review and meta-analysis to investigate the effect of vitamin D on this patient population.</p><p><strong>Methods: </strong>We searched for randomized controlled trials (RCTs) in PubMed, Embase, and the Cochrane Library databases from inception until August 15, 2024. Studies evaluating critically ill adult patients who received vitamin D compared to controls were included. The primary outcome was short-term mortality. We used the Cochrane risk of bias tool and GRADE system to evaluate the study quality and evidence. Secondary outcomes were changes in serum 25-hydroxyvitamin D levels, mechanical ventilation (MV) duration, and length of stay (LOS) in the ICU or hospital. We also conducted meta-regression, subgroup analyses, and trial sequential analysis (TSA) to explore the potential heterogeneity among the included trials.</p><p><strong>Results: </strong>Nineteen RCTs with 2,754 patients were eligible. Overall, vitamin D significantly increased serum 25-hydroxyvitamin D levels and significantly reduced the short-term mortality (risk ratio [RR] = 0.83; 95%CI, 0.70-0.98; <i>p</i> = 0.03, <i>I</i> <sup>2</sup> = 13%), duration of MV (MD = -2.96 days; 95% CI, -5.39 to -0.52; <i>I</i> <sup>2</sup> = 77%; <i>p</i> = 0.02) and ICU LOS (MD = -2.66 days; 95% CI, -4.04 to -1.29, <i>I</i> <sup>2</sup> = 70%; <i>p</i> = 0.0001) but not hospital LOS (MD = -0.48 days; 95% CI, -2.37 to 1.40; <i>I</i> <sup>2</sup> = 31%; <i>p</i> = 0.61). The meta-regression analysis revealed that the proportion of MV (MV%) accounted for the source of heterogeneity, and the subgroup analyses based on MV% suggested that the MV group was more likely to benefit from vitamin D applications than the partly MV group in all the predefined outcomes (all <i>p</i> values<0.05). TSA for short-term mortality suggested that more data is required to confirm our main conclusion.</p><p><strong>Conclusion: </strong>Vitamin D supplementation increased serum 25-hydroxyvitamin D levels and significantly benefited critically ill patients, especially those with MV.</p><p><strong>Systematic review registration: </strong>https://inplasy.com/inplasy-2022-10-0074/, INPLASY2022100074.</p>","PeriodicalId":12473,"journal":{"name":"Frontiers in Nutrition","volume":"12 ","pages":"1505616"},"PeriodicalIF":4.0000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075268/pdf/","citationCount":"0","resultStr":"{\"title\":\"Vitamin D supplementation in critically ill patients: a meta-analysis.\",\"authors\":\"Wen-He Zheng, Jia-Heng Shi, Da-Xing Yu, Hui-Bin Huang\",\"doi\":\"10.3389/fnut.2025.1505616\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Vitamin D is commonly used in clinical practice, while its clinical significance in critically ill patients remains controversial. Therefore, we aimed to perform a systemic review and meta-analysis to investigate the effect of vitamin D on this patient population.</p><p><strong>Methods: </strong>We searched for randomized controlled trials (RCTs) in PubMed, Embase, and the Cochrane Library databases from inception until August 15, 2024. Studies evaluating critically ill adult patients who received vitamin D compared to controls were included. The primary outcome was short-term mortality. We used the Cochrane risk of bias tool and GRADE system to evaluate the study quality and evidence. Secondary outcomes were changes in serum 25-hydroxyvitamin D levels, mechanical ventilation (MV) duration, and length of stay (LOS) in the ICU or hospital. We also conducted meta-regression, subgroup analyses, and trial sequential analysis (TSA) to explore the potential heterogeneity among the included trials.</p><p><strong>Results: </strong>Nineteen RCTs with 2,754 patients were eligible. Overall, vitamin D significantly increased serum 25-hydroxyvitamin D levels and significantly reduced the short-term mortality (risk ratio [RR] = 0.83; 95%CI, 0.70-0.98; <i>p</i> = 0.03, <i>I</i> <sup>2</sup> = 13%), duration of MV (MD = -2.96 days; 95% CI, -5.39 to -0.52; <i>I</i> <sup>2</sup> = 77%; <i>p</i> = 0.02) and ICU LOS (MD = -2.66 days; 95% CI, -4.04 to -1.29, <i>I</i> <sup>2</sup> = 70%; <i>p</i> = 0.0001) but not hospital LOS (MD = -0.48 days; 95% CI, -2.37 to 1.40; <i>I</i> <sup>2</sup> = 31%; <i>p</i> = 0.61). The meta-regression analysis revealed that the proportion of MV (MV%) accounted for the source of heterogeneity, and the subgroup analyses based on MV% suggested that the MV group was more likely to benefit from vitamin D applications than the partly MV group in all the predefined outcomes (all <i>p</i> values<0.05). TSA for short-term mortality suggested that more data is required to confirm our main conclusion.</p><p><strong>Conclusion: </strong>Vitamin D supplementation increased serum 25-hydroxyvitamin D levels and significantly benefited critically ill patients, especially those with MV.</p><p><strong>Systematic review registration: </strong>https://inplasy.com/inplasy-2022-10-0074/, INPLASY2022100074.</p>\",\"PeriodicalId\":12473,\"journal\":{\"name\":\"Frontiers in Nutrition\",\"volume\":\"12 \",\"pages\":\"1505616\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075268/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Nutrition\",\"FirstCategoryId\":\"97\",\"ListUrlMain\":\"https://doi.org/10.3389/fnut.2025.1505616\",\"RegionNum\":2,\"RegionCategory\":\"农林科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Nutrition","FirstCategoryId":"97","ListUrlMain":"https://doi.org/10.3389/fnut.2025.1505616","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
Vitamin D supplementation in critically ill patients: a meta-analysis.
Background: Vitamin D is commonly used in clinical practice, while its clinical significance in critically ill patients remains controversial. Therefore, we aimed to perform a systemic review and meta-analysis to investigate the effect of vitamin D on this patient population.
Methods: We searched for randomized controlled trials (RCTs) in PubMed, Embase, and the Cochrane Library databases from inception until August 15, 2024. Studies evaluating critically ill adult patients who received vitamin D compared to controls were included. The primary outcome was short-term mortality. We used the Cochrane risk of bias tool and GRADE system to evaluate the study quality and evidence. Secondary outcomes were changes in serum 25-hydroxyvitamin D levels, mechanical ventilation (MV) duration, and length of stay (LOS) in the ICU or hospital. We also conducted meta-regression, subgroup analyses, and trial sequential analysis (TSA) to explore the potential heterogeneity among the included trials.
Results: Nineteen RCTs with 2,754 patients were eligible. Overall, vitamin D significantly increased serum 25-hydroxyvitamin D levels and significantly reduced the short-term mortality (risk ratio [RR] = 0.83; 95%CI, 0.70-0.98; p = 0.03, I2 = 13%), duration of MV (MD = -2.96 days; 95% CI, -5.39 to -0.52; I2 = 77%; p = 0.02) and ICU LOS (MD = -2.66 days; 95% CI, -4.04 to -1.29, I2 = 70%; p = 0.0001) but not hospital LOS (MD = -0.48 days; 95% CI, -2.37 to 1.40; I2 = 31%; p = 0.61). The meta-regression analysis revealed that the proportion of MV (MV%) accounted for the source of heterogeneity, and the subgroup analyses based on MV% suggested that the MV group was more likely to benefit from vitamin D applications than the partly MV group in all the predefined outcomes (all p values<0.05). TSA for short-term mortality suggested that more data is required to confirm our main conclusion.
Conclusion: Vitamin D supplementation increased serum 25-hydroxyvitamin D levels and significantly benefited critically ill patients, especially those with MV.
期刊介绍：
No subject pertains more to human life than nutrition. The aim of Frontiers in Nutrition is to integrate major scientific disciplines in this vast field in order to address the most relevant and pertinent questions and developments. Our ambition is to create an integrated podium based on original research, clinical trials, and contemporary reviews to build a reputable knowledge forum in the domains of human health, dietary behaviors, agronomy & 21st century food science. Through the recognized open-access Frontiers platform we welcome manuscripts to our dedicated sections relating to different areas in the field of nutrition with a focus on human health.
Specialty sections in Frontiers in Nutrition include, for example, Clinical Nutrition, Nutrition & Sustainable Diets, Nutrition and Food Science Technology, Nutrition Methodology, Sport & Exercise Nutrition, Food Chemistry, and Nutritional Immunology. Based on the publication of rigorous scientific research, we thrive to achieve a visible impact on the global nutrition agenda addressing the grand challenges of our time, including obesity, malnutrition, hunger, food waste, sustainability and consumer health.
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