Περίληψη:
Introduction
Pneumonia severity index (PSI) is a prognostic index used for estimating
the possibility of death due to community-acquired pneumonia. Vitamin D
is a fat-soluble vitamin, essential for calcium and phosphate
homeostasis. Vitamin D also has antimicrobial properties and according
to recent studies, its deficiency may be correlated to an increased
frequency of respiratory infections. The serum concentration of
25-hydroxyvitamin D (25(OH)D) is the best vitamin D status index
reflecting vitamin D produced in the skin and offered from food and
dietary supplements.
Methods
The study involved patients, who fulfilled the criteria of
community-acquired pneumonia. The exclusion criteria were: patients <18
years old, severely immunocompromised patients, patients with
tuberculosis, patients with malabsorption disorders, nursing home
residents, patients with a history of malignancy, chronic renal or liver
disease, patients with congestive health failure or cerebrovascular
disease, and patients receiving vitamin D as a supplement. The following
parameters, recorded on admission, were evaluated: age, sex,
co-morbidity, residence in a nursing home, duration of symptoms,
clinical symptoms, confusion, blood gas analysis, chest radiograph
(pleural effusion), and laboratory parameters. The patients were
classified in risk classes according to the PSI. Blood samples were
collected within the first 48 hours of hospitalization. The serum levels
of 25-hydroxyvitamin D were determined by electrochemiluminescence
binding assay in Roche Cobas 601 immunoassay analyzer and mean serum
levels of 25-hydroxyvitamin D in each risk class were calculated. For
statistical analysis, the statistical program SPSS for Windows version
17.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago,
IL) was used.
Results
A total of 46 patients, 28 males and 18 females, with a mean age of 71.5
+/- 17.57 years, hospitalized with community-acquired pneumonia, were
included. Sixteen patients (35%) had a severe deficiency, with 25(OH)D
levels <10 ng/ml, 17 patients (37%) had moderate deficiency with
25(OH)D levels between 10-20 ng/ml, and 13 patients (28%) had
insufficiency with 25(OH)D levels between 20-29 ng/ml. According to the
PSI, four (8.7%) patients with a mean age of 53.75 +/- 15.43 years were
classified as risk class I, 10 (21.7%) patients with a mean age of 54.7
+/- 14.82 years as class II, 10 (21.7%) patients with a mean age of
68.41 +/- 3.96 years as class III, 17 (37%) patients with a mean age of
84.82 +/- 9.73 years as class IV, and five (10.9%) patients with a mean
age of 80.2 +/- 9.41 years as class V. The mean levels of 25(OH)D were
19.11 +/- 11.24 ng/ml in class I, 16.81 +/- 8.94 ng/ml in class II,
16.65 +/- 9.18 ng/ml in class III, 14.76 +/- 10.22 ng/ml in class IV,
and 7.49 +/- 4.41 ng/ml in class V. There was a positive correlation
between low levels of 25(OH)D and the pneumonia severity and
statistically significant difference between the mean levels of 25(OH)D
in class V (7.49 +/- 4.41 ng/ml) compared to overall mean levels in
classes I, II, III and IV (16.15 +/- 9.49 ng/ml), with p<0.05.
Conclusions
According to our results, there was a positive association between low
levels of 25-hydroxyvitamin D and community-acquired pneumonia severity
assessed by PSI. The determination of 25-hydroxyvitamin-D status, mostly
in patients >60 years old, may prevent severe community-acquired
pneumonia.
Συγγραφείς:
Georgakopoulou, Vasiliki E.
Mantzouranis, Konstantinos
Damaskos,
Christos
Karakou, Evgenia
Melemeni, Despoina
Mermigkis,
Dimitrios
Petsinis, Georgios
Sklapani, Pagona
Trakas,
Nikolaos
Tsiafaki, Xanthi
