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心血管疾病和脑血管疾病索引住院患者中维生素D缺乏症的患病率及相关结局——一项全国性研究

Prevalence and Outcomes Associated with Vitamin D Deficiency among Indexed Hospitalizations with Cardiovascular Disease and Cerebrovascular Disorder-A Nationwide Study.

作者信息

Patel Urvish, Yousuf Salma, Lakhani Komal, Raval Payu, Kaur Nirmaljot, Okafor Toochukwu, Shah Chail, Singh Harmandeep, Martin Mehwish, Nwodika Chika, Yogarajah Angelina, Rakholiya Jigisha, Patel Maitree, Chakinala Raja Chandra, Shah Shamik

机构信息

Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

Department of Internal Medicine, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA.

出版信息

Medicines (Basel). 2020 Nov 22;7(11):72. doi: 10.3390/medicines7110072.

Abstract

: According to past studies, recovery and survival following severe vascular events such as acute myocardial infarction and stroke are negatively impacted by vitamin D deficiency. However, the national estimate on disability-related burden is unclear. We intend to evaluate the prevalence and outcomes of vitamin D deficiency (VDD) among patients with cardiovascular disease (CVD) and cerebrovascular disorder (CeVD). : We performed a cross-sectional study on the Nationwide Inpatient Sample data (2016-2017) of adult (≥18 years) hospitalizations. We identified patients with a secondary diagnosis of VDD and a primary diagnosis of CVD and CeVD using the 9th revision of the International Classification of Diseases, clinical modification code (ICD-10-CM) codes. A univariate and mixed-effect multivariable survey logistic regression analysis was performed to evaluate the prevalence, disability, and discharge disposition of patients with CVD and CeVD in the presence of VDD. : Among 58,259,589 USA hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23%, and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH, and SAH, respectively and 1.82% had VDD. The prevalence of hospitalizations due to CHF (14.66% vs. 11.43%), AIS (1.87% vs. 1.71%), and TIA (0.4% vs. 0.38%) was higher among VDD patients as compared with non-VDD patients ( < 0.0001). In a regression analysis, as compare with non-VDD patients, the VDD patients were associated with higher odds of discharge to non-home facilities with an admission diagnosis of CHF (aOR 1.08, 95% CI 1.07-1.09), IHD (aOR 1.24, 95% CI 1.21-1.28), acute MI (aOR 1.23, 95% CI 1.19-1.28), AFib (aOR 1.21, 95% CI 1.16-1.27), and TIA (aOR 1.19, 95% CI 1.11-1.28). VDD was associated with higher odds of severe or extreme disability among patients hospitalized with AIS (aOR 1.1, 95% CI 1.06-1.14), ICeH (aOR 1.22, 95% CI 1.08-1.38), TIA (aOR 1.36, 95% CI 1.25-1.47), IHD (aOR 1.37, 95% CI 1.33-1.41), acute MI (aOR 1.44, 95% CI 1.38-1.49), AFib (aOR 1.10, 95% CI 1.06-1.15), and CHF (aOR 1.03, 95% CI 1.02-1.05) as compared with non-VDD. : CVD and CeVD in the presence of VDD increase the disability and discharge to non-home facilities among USA hospitalizations. Future studies should be planned to evaluate the effect of VDD replacement for improving outcomes.

摘要

根据以往研究,维生素D缺乏会对急性心肌梗死和中风等严重血管事件后的恢复和生存产生负面影响。然而,全国范围内与残疾相关负担的估计尚不清楚。我们旨在评估心血管疾病(CVD)和脑血管疾病(CeVD)患者中维生素D缺乏(VDD)的患病率及后果。

我们对全国住院患者样本数据(2016 - 2017年)中成年(≥18岁)住院病例进行了一项横断面研究。我们使用国际疾病分类第9版临床修订版代码(ICD - 10 - CM)识别出二级诊断为VDD且一级诊断为CVD和CeVD的患者。进行了单变量和混合效应多变量调查逻辑回归分析,以评估存在VDD时CVD和CeVD患者的患病率、残疾情况及出院去向。

在美国58,259,589例住院病例中,分别有3.44%、2.15%、0.06%、1.28%、11.49%、1.71%、0.38%、0.23%和0.08%的患者主要诊断为缺血性心脏病(IHD)、急性心肌梗死(MI)、心绞痛、房颤(AFib)、心力衰竭(CHF)、急性缺血性卒中(AIS)、短暂性脑缺血发作(TIA)、颅内出血(ICeH)和蛛网膜下腔出血(SAH),1.82%的患者存在VDD。与非VDD患者相比,VDD患者中因CHF(14.66%对11.43%)、AIS(1.87%对1.71%)和TIA(0.4%对0.38%)住院的患病率更高(P < 0.0001)。在回归分析中,与非VDD患者相比,VDD患者因CHF(调整后比值比[aOR] 1.08,95%置信区间[CI] 1.07 - 1.09)、IHD(aOR 1.24,95% CI 1.21 - 1.28)、急性MI(aOR 1.23,95% CI 1.19 - 1.28)、AFib(aOR 1.21,95% CI 1.16 - 1.27)和TIA(aOR 1.19,95% CI 1.11 - 1.28)入院诊断而被转至非家庭机构出院的几率更高。与非VDD患者相比,VDD与因AIS(aOR 1.1,95% CI 1.06 - 1.14)、ICeH(aOR 1.22,95% CI 1.08 - 1.38)、TIA(aOR 1.36,95% CI 1.25 - 1.47)、IHD(aOR 1.37,95% CI 1.33 - 1.41)、急性MI(aOR 1.44,95% CI 1.38 - 1.49)、AFib(aOR 1.10,95% CI 1.06 - 1.15)和CHF(aOR 1.03,95% CI 1.02 - 1.05)住院患者出现严重或极度残疾的几率更高有关。

在美国住院病例中,存在VDD的CVD和CeVD会增加残疾率以及转至非家庭机构出院的几率。应规划未来研究以评估补充VDD对改善预后的效果。

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