Independent Association Of Circulating Vitamin D Metabolites With Anemia Risk In Patients Scheduled For Cardiac Surgery
PLOS ONE(2015)
摘要
BackgroundPreoperative anemia is considered an independent risk factor of poor clinical outcome in cardiac surgical patients. Low vitamin D status may increase anemia risk.MethodsWe investigated 3,615 consecutive patients scheduled for cardiac surgery to determine the association between preoperative anemia (hemoglobin [Hb] < 12.5 g/dL) and circulating levels of the vitamin D metabolites 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25[OH](2)D).ResultsOf the study cohort, 27.8% met the criteria for anemia. In patients with deficient 25OHD levels (<30 nmol/l) mean Hb concentrations were 0.5 g/dL lower than in patients with adequate 25OHD levels (50.0-125 nmol/l; P<0.001). Regarding 1,25(OH)(2)D, mean Hb concentrations were 1.2 g/dL lower in the lowest 1,25(OH)(2)D category (<40 pmol/l) than in the highest 1,25(OH)(2)D category (>70 pmol/l; P<0.001). In multivariable-adjusted logistic regression analyses, the odds ratios for anemia of the lowest categories of 25OHD and 1,25(OH)(2)D were 1.48 (95% CI: 1.19-1.83) and 2.35 (95% CI: 1.86-2.97), compared with patients who had adequate 25OHD levels and 1,25(OH)(2)D values in the highest category, respectively. Anemia risk was greatest in patients with dual deficiency of 25OHD and 1,25(OH)(2)D (multivariable-adjusted OR = 3.60 (95% CI: 2.40-5.40). Prevalence of deficient 25OHD levels was highest in anemia of nutrient deficiency, whereas low 1,25(OH)(2)D levels were most frequent in anemia of chronic kidney disease.ConclusionThis cross-sectional study demonstrates an independent inverse association between vitamin D status and anemia risk. If confirmed in clinical trials, preoperative administration of vitamin D or activated vitamin D (in case of chronic kidney disease) would be a promising strategy to prevent anemia in patients scheduled for cardiac surgery.
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