1
|
Zhou Y, Zhang S, Chen Z, Zhang X, Feng Y, Xu R. The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study. Nutr J 2024; 23:81. [PMID: 39026252 PMCID: PMC11256428 DOI: 10.1186/s12937-024-00982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Data is limited on the prevalence of hypophosphatemia in general hospitalized patients, and its association with length of hospital stay (LOS) and mortality remained unclear. We aimed to investigate the prevalence of admission phosphate abnormality and the association between serum phosphate level and length of hospital stay and all-cause mortality in adult patients. METHODS This was a multi-center retrospective study based on real-world data. Participants were classified into five groups according to serum phosphate level (inorganic phosphorus, iP) within 48 h after admission: G1, iP < 0.64 mmol/L; G2, iP 0.64-0.8 mmol/L; G3, iP 0.8-1.16 mmol/L; G4, iP 1.16-1.45 mmol/L; and G5, iP ≥ 1.45 mmol/L, respectively. Both LOS and in-hospital mortality were considered as outcomes. Clinical information, including age, sex, primary diagnosis, co-morbidity, and phosphate-metabolism related parameters, were also abstracted from medical records. RESULTS A total number of 23,479 adult patients (14,073 males and 9,406 females, aged 57.7 ± 16.8 y) were included in the study. The prevalence of hypophosphatemia was 4.74%. An "L-shaped" non-linear association was determined between serum phosphate level and LOS and the inflection point was 1.16 mmol/L in serum phosphate level. Compared with patients in G4, patients in G1, G2 or G3 were significantly associated with longer LOS after full adjustment of covariates. Each 0.1 mmol/L decrease in serum phosphate level to the left side of the inflection point led to 0.64 days increase in LOS [95% confidence interval (CI): 0.46, 0.81; p for trend < 0.001]. But there was no association between serum phosphate and LOS where serum levels of phosphate ≥ 1.16 mmol/L. Multivariable logistic regression analysis showed that adjusted all-cause in-hospital mortality was 3.08-fold greater in patients in G1 than those in G4 (95% CI: 1.52, 6.25; p for trend = 0.001). Similarly, no significant association with either LOS or mortality were found in patients in G5, comparing with G4. CONCLUSIONS Hypophosphatemia, but not hyperphosphatemia, was associated with LOS and all-cause mortality in adult inpatients. It is meaningful to monitor serum levels of phosphate to facilitate early diagnosis and intervention.
Collapse
Affiliation(s)
- Yiquan Zhou
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Shuyi Zhang
- Intensive Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Zhiqi Chen
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xiaomin Zhang
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yi Feng
- Department of Clinical Nutrition Center, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Department of Nutrition, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| |
Collapse
|
2
|
Wang Y, Feng S, Shi H, Lu Y, Zhang J, Zhang W, Xu Y, Liang Q, Sun L. Analysis of alterations in serum vitamins and correlations with gut microbiome, microbial metabolomics in patients with sepsis. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1237:124101. [PMID: 38547698 DOI: 10.1016/j.jchromb.2024.124101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Vitamins are essential micronutrients that play key roles in many biological pathways associated with sepsis. The gut microbiome plays a pivotal role in the progression of sepsis and may contribute to the onset of multi-organ dysfunction syndrome (MODS). The aim of this study was to investigate the changes in serum vitamins, and their correlation with intestinal flora and metabolomic profiles in patients with sepsis. METHODS The serum levels of vitamins were determined by Ultra Performance Liquid Chromatography (UPLC). 16S rRNA gene sequencing and Liquid Chromatography-tandem Mass Spectrometry (LC-MS/MS) targeted metabolomics were used for microbiome and metabolome analysis. RESULTS In the training cohort: After univariate, multivariate (OPLS-DA) and Spearman analyses, it was concluded that vitamin levels of 25 (OH) VD3 and (VD2 + VD3), as well as vitamins A and B9, differed significantly among healthy controls (HC), non-septic critical patients (NS), and sepsis patients (SS) (P < 0.05). The validation cohort confirmed the differential vitamin findings from the training cohort. Moreover, analyses of gut flora and metabolites in septic patients and healthy individuals revealed differential flora, metabolites, and metabolic pathways that were linked to alterations in serum vitamin levels. We found for the first time that vitamin B9 was negatively correlated with g_Sellimonas. CONCLUSION Sepsis patients exhibited significantly lower levels of 25 (OH) VD3 and (VD2 + VD3), vitamins A and B9, which hold potential as predictive markers for sepsis prognosis. The changes in these vitamins may be associated with inflammatory factors, oxidative stress, and changes in gut flora.
Collapse
Affiliation(s)
- Yingchen Wang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Susu Feng
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Hongwei Shi
- Department of Emergency Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Yuxin Lu
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Jingtao Zhang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Wanglin Zhang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Yuzhi Xu
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Qi Liang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Liqun Sun
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China.
| |
Collapse
|
3
|
Yang B, Zhu Y, Zheng X, Li T, Niu K, Wang Z, Lu X, Zhang Y, Shen C. Vitamin D Supplementation during Intensive Care Unit Stay Is Associated with Improved Outcomes in Critically Ill Patients with Sepsis: A Cohort Study. Nutrients 2023; 15:2924. [PMID: 37447250 DOI: 10.3390/nu15132924] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Vitamin D, as a common micronutrient, has been widely used in critically ill patients. However, whether supplementation of vitamin D in adult patients with sepsis can improve their prognosis remains controversial. METHODS Data from the Mart for Intensive Care IV database was used in this retrospective cohort study, and adult patients with sepsis were enrolled. Critically ill patients, admitted to intensive care units (ICUs) between 2008 and 2019 at the Beth Israel Deaconess Medical Center (BIDMC), were divided into the vitamin D supplementation group and non-vitamin D supplementation group. The primary outcomes were defined as all-cause in-hospital, 28-day, and 90-day mortality rates after admission to the ICU. A 1:1 propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) analyses were used to minimize selection bias and balance the baseline demographic characteristics. Regression and survival analyses were performed to assess the association between vitamin D supplementation and clinical outcomes in patients with sepsis. RESULTS In total, 3539 patients with sepsis were enrolled as study participants; of these, 315 were supplemented with vitamin D during their ICU stay. In-hospital, 28-day, and 90-day mortality rates were significantly lower in patients with sepsis supplemented with vitamin D. Multivariate regression analysis showed vitamin D supplementation as a potential protective factor for in-hospital mortality with an odds ratio (OR) = 0.70 (0.51-0.96) after adjusting for all confounders. The hazard ratios (HRs) for 28-day and 90-day mortality were 0.65 (0.50-0.85) and 0.70 (0.55-0.90), respectively. The survival analysis showed that the vitamin D supplementation group had a higher survival probability within 28 and 90 days (p-value < 0.05). These results remained relatively stable post PSM, IPTW, and OW. However, we found no evidence that vitamin D supplementation could shorten the length of stay in the ICU or hospital. CONCLUSIONS Vitamin D supplementation during an ICU stay was associated with improved prognosis in patients with sepsis, as evidenced by lower in-hospital, 28-day, and 90-day mortality rates and lower disease severity-related scores, but showed no influence on the length of stay in the hospital or ICU.
Collapse
Affiliation(s)
- Boshen Yang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200235, China
| | - Yuankang Zhu
- School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Xinjie Zheng
- International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 310030, China
| | - Taixi Li
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200235, China
| | - Kaifan Niu
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200235, China
| | - Zhixiang Wang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200235, China
| | - Xia Lu
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200235, China
| | - Yan Zhang
- Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 201203, China
| | - Chengxing Shen
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200235, China
| |
Collapse
|
4
|
Vitamin D Deficiency: An Underestimated Factor in Sepsis? Int J Mol Sci 2023; 24:ijms24032924. [PMID: 36769240 PMCID: PMC9917708 DOI: 10.3390/ijms24032924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Vitamin D is an important immune modulator that is linked to infection susceptibility. It has been suggested that vitamin D deficiency plays a role in sepsis and septic shock because vitamin-D-related pathways are associated with various immunological, endocrine, and endothelial functions. Previous research has yielded inconclusive results regarding the link between mortality and vitamin D deficiency in sepsis patients. In patients with sepsis and severe vitamin D deficiency, an adequate vitamin D concentration may reduce mortality. Randomized controlled trials to assess the influence of vitamin D supplementation on clinical outcomes in sepsis patients with vitamin D deficiency are uncommon. We will provide an overview of the current knowledge about the relationship between vitamin D and sepsis in this review, as well as consider the potential value of vitamin D supplementation in this situation.
Collapse
|
5
|
Vanichkulbodee A, Romposra M, Inboriboon PC, Trongtrakul K. Effects of vitamin D insufficiency on sepsis severity and risk of hospitalisation in emergency department patients: a cross-sectional study. BMJ Open 2023; 13:e064985. [PMID: 36653058 PMCID: PMC9853214 DOI: 10.1136/bmjopen-2022-064985] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the association of 25-hydroxyvitamin D (25(OH)D) level on sepsis severity and risk of hospitalisation in emergency department (ED) septic patients when categorised as vitamin D insufficiency according to the level of 25(OH)D<30 ng/mL. DESIGN Cross-sectional observational study. SETTING A 900-bed academic tertiary hospital with an ED residency training programme in Bangkok, Thailand. PARTICIPANTS An observational study of 101 ED septic patients aged ≥18 years was conducted between March 2015 and September 2015. OUTCOME MEASURES The level of 25(OH)D was analysed and correlated with sepsis severity assessed by Acute Physiology Age Chronic Health Evaluation-II (APACHE-II) and Mortality in ED Sepsis (MEDS) scores, and the risk of hospitalisation. RESULTS One hundred and one patients were enrolled, with an average age of 68±18 years, 56% female, APACHE-II score of 14±6, MEDS score of 8±5 and 25(OH)D level was 19±11 ng/mL. The prevalence of vitamin D insufficiency in our ED septic patients was 87% and the admission rate was 88%. A significant association between 25(OH)D level and sepsis severity scores was found, which was measured by APACHE-II and MEDS scores (-0.29; 95% CI -0.41 to -0.17, p<0.001 and -0.15; 95% CI -0.25 to -0.06, p=0.002, respectively). However, vitamin D insufficiency could not determine hospitalisation (OR=1.42; 95% CI 0.27 to 7.34; p=0.68 and OR=1.65; 95% CI 0.07 to 41.7; p=0.76 when adjusted by baseline covariates). CONCLUSIONS The vitamin D insufficiency of septic patients in our ED was high and had a significant negative association with sepsis severity. However, vitamin D insufficiency status cannot predict the hospitalisation of septic patients who were admitted to the ED. Further research is needed to investigate the role of vitamin D supplementation in the ED in affecting sepsis severity. TRIAL REGISTRATION NUMBER TCTR20151127001.
Collapse
Affiliation(s)
- Alissara Vanichkulbodee
- Department of Emergency Medicine, Navamindradhiraj University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
| | - Muditha Romposra
- Department of Emergency Medicine, Navamindradhiraj University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
- Emergency Room, Sukhumvit Hospital, Bangkok, Thailand
| | | | - Konlawij Trongtrakul
- Department of Internal Medicine, Division of Critical Care, Navamindradhiraj University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Allergy, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| |
Collapse
|
6
|
Tofe-Valera I, Pérez-Navero JL, Caballero-Villarraso J, Cañete MD, Villa-Jiménez R, De la Torre-Aguilar MJ. Vitamin d deficiency with high parathyroid hormone levels is related to late onset SEPSIS among preterm infants. BMC Pregnancy Childbirth 2023; 23:23. [PMID: 36639750 PMCID: PMC9838010 DOI: 10.1186/s12884-022-05334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Preterm infants (PTs) are at greater risk for vitamin D deficiency, which relates to the possibility of a higher incidence of comorbidities. Our goal was twofold, 1) to monitor vitamin D, calcium, phosphorus, parathyroid hormone (PTH), matrix metalloproteinase-8 (MMP-8) serum levels at three-time points during hospitalization, and 2) to assess the association between 25-hydroxyvitamin D (25OHD) levels and outcomes in PTs. METHODS We carried out a follow-up on 50 Caucasian PTs ≤ 32 weeks of gestational age (GA) and/or ≤ 1500 g birth weight at 28 days and at 4 months. PTs were divided into two subgroups for tests of association with clinical outcomes based on vitamin D deficient infants 25(OH) D cord blood levels: ≤ 20 ng/ml). At an initial stage, 25(OH) D levels were determined in maternal/preterm blood samples and were compared to full term delivery infants. RESULTS There were no differences in 25(OH) D serum levels at birth when comparing PTs to term infants, or regarding maternal levels. A strong positive correlation was detected between maternal and neonatal 25(OH) D serum levels among PTs and term infants (r: 0.466; p < 0.001). Neonates with vitamin D deficiency did not present a higher incidence of comorbidities. PTs were classified in two subgroups based on vitamin D and PTH (group 1: vitamin D < 20 ng/mL and PTH > 60 pg/mL; group 2: vitamin D > 20 and PTH < 60 pg/mL). The PTs in group 1 showed a higher incidence of LOS (RR: 2; 95% CI: 1.31-3.55). No relationship was observed between MMP-8 serum levels and the incidence of sepsis. CONCLUSIONS This study did not find any evidence of an increase in preterm birth risk related to vitamin D level at birth. Vitamin D deficiency by itself is not associated with a higher incidence of comorbidities. However, the binomial vitamin D-PTH must be taken into consideration.
Collapse
Affiliation(s)
- I. Tofe-Valera
- grid.428865.50000 0004 0445 6160Neonatology, Department of Pediatrics Unit, Reina Sofia University Hospital. Córdoba. Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - J. L. Pérez-Navero
- grid.411349.a0000 0004 1771 4667Department of Pediatrics, Unit of Pediatric Research, Reina Sofia University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain ,grid.413448.e0000 0000 9314 1427CIBERObn Center for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain ,grid.411901.c0000 0001 2183 9102School of Medicine, University of Córdoba, Córdoba, Spain ,grid.428865.50000 0004 0445 6160Pediatric Research Unit, Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Ave. Menéndez Pidal 7. P. C. 14004, Córdoba, Spain
| | - J. Caballero-Villarraso
- grid.411349.a0000 0004 1771 4667Department of Biochemistry and Molecular Biology, Clinical Analyses Service, Reina Sofia University Hospital, Córdoba, Spain
| | - M. D. Cañete
- grid.411349.a0000 0004 1771 4667Department of Biochemistry and Molecular Biology, Clinical Analyses Service, Reina Sofia University Hospital, Córdoba, Spain
| | - R. Villa-Jiménez
- grid.411901.c0000 0001 2183 9102Associate Professor at Córdoba University (UCO), Córdoba, Spain
| | - M. J. De la Torre-Aguilar
- grid.411349.a0000 0004 1771 4667Department of Pediatrics, Unit of Pediatric Research, Reina Sofia University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| |
Collapse
|
7
|
Domenici R, Vierucci F. Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052973. [PMID: 35270666 PMCID: PMC8910000 DOI: 10.3390/ijerph19052973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/01/2023]
Abstract
Human milk is the best food for infants. Breastfeeding has been associated with a reduced risk of viral and bacterial infections. Breast milk contains the perfect amount of nutrients needed to promote infant growth, except for vitamin D. Vitamin D is crucial for calcium metabolism and bone health, and it also has extra-skeletal actions, involving innate and adaptive immunity. As exclusive breastfeeding is a risk factor for vitamin D deficiency, infants should be supplemented with vitamin D at least during the first year. The promotion of breastfeeding and vitamin D supplementation represents an important objective of public health.
Collapse
|
8
|
Abstract
Vitamins are essential micronutrients with key roles in many biological pathways relevant to sepsis. Some of these relevant biological mechanisms include antioxidant and anti-inflammatory effects, protein and hormone synthesis, energy generation, and regulation of gene transcription. Moreover, relative vitamin deficiencies in plasma are common during sepsis and vitamin therapy has been associated with improved outcomes in some adult and pediatric studies. High-dose intravenous vitamin C has been the vitamin therapy most extensively studied in adult patients with sepsis and septic shock. This includes three randomized control trials (RCTs) as monotherapy with a total of 219 patients showing significant reduction in organ dysfunction and lower mortality when compared to placebo, and five RCTs as a combination therapy with thiamine and hydrocortisone with a total of 1134 patients showing no difference in clinical outcomes. Likewise, the evidence for the role of other vitamins in sepsis remains mixed. In this narrative review, we present the preclinical, clinical, and safety evidence of the most studied vitamins in sepsis, including vitamin C, thiamine (i.e., vitamin B1), and vitamin D. We also present the relevant evidence of the other vitamins that have been studied in sepsis and critical illness in both children and adults, including vitamins A, B2, B6, B12, and E. IMPACT: Vitamins are key effectors in many biological processes relevant to sepsis. We present the preclinical, clinical, and safety evidence of the most studied vitamins in pediatric sepsis. Designing response-adaptive platform trials may help fill in knowledge gaps regarding vitamin use for critical illness and association with clinical outcomes.
Collapse
|
9
|
Abstract
Vitamin D is involved in bone health by promoting calcium absorption in the gut and maintaining serum calcium and phosphate concentrations, and by its action on bone growth and reorganization through osteoblasts and osteoclasts cells. Moreover, during the last three decades, novel actions of vitamin D have been discovered. Several systematic reviews and meta-analyses have shown links between serum vitamin D levels and non-communicable diseases. In line with these findings, a wide number of studies have suggested associations of vitamin D deficiency (VDD) with respiratory tract infections, osteoporosis, and other chronic and metabolic diseases such as obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM), cancer, rheumatoid arthritis (RA), and inflammatory bowel disease (IBD). Vitamin D also exerts important actions in the clinical course of infectious and other acute diseases, particularly respiratory bacterial infections, tuberculosis, and virus infections, e.g., those generated by human immunodeficiency and SARS-CoV-2 (COVID-19) viruses. The present article aimed to update the role of vitamin D in chronic and acute diseases. To know the role of vitamin D in the prevention and treatment of non-communicable chronic diseases. To understand how vitamin D deficiency is related to obesity, insulin resistance and metabolic syndrome, type 2 diabetes, cancer, rheumatoid arthritis, osteoporosis, chronic pulmonary obstructive disease, and inflammatory bowel disease. To know the function of vitamin D in the prevention and treatment of acute infectious diseases of bacterial and viral origins, namely respiratory infections. To understand the role of vitamin D in the prevention of HIV and SARS-Cov2 infections To know how vitamin D status affects the course of critical illness diseases
Collapse
|
10
|
Matera MG, Imperatore F, Annibale R, Cazzola M. Advances in the Pharmacological Management of Pediatric Acute Respiratory Distress Syndrome. Expert Opin Pharmacother 2021; 23:349-360. [PMID: 34781794 DOI: 10.1080/14656566.2021.2006632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Noninvasive mechanical ventilation is the main supportive measure used in patients with pediatric ARDS (PARDS), but adjunctive pharmacological therapies (corticosteroids, inhaled nitric oxide [iNO], surfactant replacement therapy and neuromuscular blocking drugs) are also used, although limited data exists to inform of this practice. AREAS COVERED The authors review the current challenges in the pharmacological management of PARDS and highlight the few certainties currently available. EXPERT OPINION Children with PARDS must not be treated as young adults with ARDS, essentially because children's lungs differ substantially from those of adults and PARDS occurs in children differently than ARDS in adults. Pharmacological treatments available for PARDS are relatively few and, since there is great uncertainty about their effectiveness also because of the extreme heterogeneity of this syndrome, it is necessary to conduct large clinical trials using currently available definitions and considering recent pathobiological knowledge. The aim is to identify homogeneous subgroups or phenotypes of children with PARDS that may benefit from the specific pharmaceutical approach examined. It will be then necessary to link endotypes and outcomes to appropriately target therapies in future trials, but this will be possible only after it will be possible to identify the different PARDS endotypes.
Collapse
Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Imperatore
- Unit of Anesthesia and Intensive Care, "San Giovanni Di Dio" Hospital, Naples, Italy
| | - Rosa Annibale
- Pharmacy Unit, "Luigi Vanvitelli" University Hospital, Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| |
Collapse
|