Kalsiyum, D vitamini ve paratiroid hormon düzeylerinin kritik hastaların prognozuna etkisi

Yıl 2022, Cilt: 47 Sayı: 3, 1129 - 1136, 30.09.2022

Esra Yakışık Çakır , Çiğdem Yücel , Murat Kızılgün , Işıl Özkoçak Turan

https://doi.org/10.17826/cumj.1124112

Öz

Amaç: Sepsisli hastalarda elektrolit ve hormonlardaki değişimi değerlendiren yeterli çalışma yoktur. Çalışmamızın amacı serum kalsiyum (Ca), magnezyum (Mg), fosfor (P), 25-hidroksivitamin D (25(OH)D) ve paratiroid hormon (PTH) düzeylerindeki değişimler ile sepsisli hastalarda mortalite arasındaki ilişkiyi değerlendirmektir.
Gereç ve Yöntem: Çalışmamız Ekim 2017-Ocak 2019 tarihleri arasında yoğun bakım ünitesinde (YBÜ) yatan sepsisli hastalar üzerinde yapılmıştır. Kalsiyum, Mg, P, 25(OH)D ve PTH düzeyleri, demografik ve klinik özellikleri ile birlikte hayatta kalan ve ölen hastalar karşılaştırıldı.
Bulgular: Çalışmaya toplam 225 hasta alındı. 225 hastanın 94'ü (%41,2) öldü ve 131'i (%58,8) taburcu edildi. Ölen hastalarda hayatta kalan hastalardan, PTH ve P seviyeleri anlamlı derecede daha yüksek, 25(OH)D, Ca ve Mg seviyeleri ise anlamlı derecede daha düşük bulundu.
Sonuç: Sepsis sırasında hassas bir denge içinde olan Ca metabolizmasının hipokalsemi, hipomagnezemi, hiperfosfatemi, düşük 25(OH)D ve yüksek PTH yönünde değişmesi mortalite ile ilişkilendirildi.

Anahtar Kelimeler

25-hidroksivitamin D, kalsiyum, mortalite, paratiroid hormon, sepsis

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

The influence of calcium, vitamin D and parathyroid hormone levels on the prognosis of critical patients

Öz

Purpose: There are not enough studies evaluating the change in electrolytes and hormones in patients with sepsis. The aim of our study is to evaluate the relationship between the changes in serum calcium (Ca), magnesium (Mg), phosphorus (P), 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) levels and mortality in patients with sepsis.
Materials and Methods: Our study was conducted on patients with sepsis who were hospitalized in the intensive care unit (ICU) between October 2017 and January 2019. The levels of Ca, Mg, P, 25(OH)D and PTH, together with demographic and clinical characteristics of non-survivor and survivor patients, were compared.
Results: A total of 225 patients were enrolled into the study. Of the 225 patients, 94 patients (41.2%) died and 131 patients (58.8%) were discharged. PTH and P levels were found to be significantly higher, and 25(OH)D, Ca, and Mg levels were significantly lower in non-survivor patients than in survivor patients.
Conclusions: During sepsis, the change in Ca metabolism which is in a delicate balance, in the direction of hypocalcemia, hypomagnesemia, hyperphosphatemia, low 25(OH)D and high PTH were found to be associated with mortality.

Anahtar Kelimeler

25-hydroxyvitamin D, calcium, mortality, parathyroid hormone, sepsis

Proje Numarası

yok

Kaynakça

• Referans1 Greulich T, Regner W, Branscheidt M, Herr C, Koczulla AR, Vogelmeier CF, et al. Altered blood levels of vitamin D, cathelicidin and parathyroid hormone in patients with sepsis-a pilot study. Anaesth Intensive Care. 2017;45:36-45.
• Referans2 Hendy GN, Canaff L. Calcium-sensing receptor, proinflammatory cytokines and calcium homeostasis. Semin Cell Dev Biol. 2016;49:37-43.
• Referans3 Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med. 2013;28:166-77.
• Referans4 Collage RD, Howell GM, Zhang X, Stripay JL, Lee JS, Angus DC, et al. Calcium supplementation during sepsis exacerbates organ failure and mortality via calcium/calmodulin-dependent protein kinase kinase signaling. Crit Care Med. 2013;41:e352-60.
• Referans5 Velissaris D, Karamouzos V, Pierrakos C, Aretha D, Karanikolas M. Hypomagnesemia in Critically Ill Sepsis Patients. J Clin Med Res. 2015;7:911-8. http://dx.doi.org/10.14740/jocmr2351w.
• Referans6 Ratzinger F, Haslacher H, Stadlberger M, Schmidt RL, Obermüller M, Schmetterer KG, et al. 25(OH)D and 1,25(OH)D vitamin D fails to predict sepsis and mortality in a prospective cohort study. Sci Rep. 2017;7:40646.
• Referans7 Upala S, Sanguankeo A, Permpalung N. Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis. BMC Anesthesiol. 2015;15:84.
• Referans8 Nguyen HB, Eshete B, Lau KH, Sai A, Villarin M, Baylink D. Serum 1,25-dihydroxyvitamin D: an outcome prognosticator in human sepsis. PLoS One. 2013;8:e64348.
• Referans9 Kamr AM, Dembek KA, Hildreth BE, Morresey PR, Rathgeber RA, Burns TA, et al. The FGF-23/klotho axis and its relationship with phosphorus, calcium, vitamin D, PTH, aldosterone, severity of disease, and outcome in hospitalised foals. Equine Vet J. 2018;50:739-746.
• Referans10 Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-10.
• Referans11 Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250-6.
• Referans12 Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486-552.
• Referans13 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
• Referans14 Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707-10.
• Referans15 EUCAST. Clinical breakpoints [Internet]. 2016. http://www.eucast.org/clinical_breakpoints/ (accessed October 2021).
• Referans16 Lind L, Carlstedt F, Rastad J, Stiernström H, Stridsberg M, Ljunggren O, et al. Hypocalcemia and parathyroid hormone secretion in critically ill patients. Crit Care Med. 2000;28:93-9.
• Referans17 Cakir E, Kocabeyoglu GM, Gurbuz O, Baltaci Ozen S, Mutlu NM, Ozkocak Turan I. Evaluation of mortality rate and risk factors in intensive care unit. Ankara Egt Ars Hast Derg 2020;53:20-24.
• Referans18 Geyik FD, Yuce Y, Erkal KH, Cevik B, Citak N. The Use of Quick Sofa (Qsofa) in Elderly Patients with Sepsis in the Intensive Care Unit. Turkish Journal of Geriatrics 2018; 21:143-9.
• Referans19 Burchard KW, Simms HH, Robinson A, DiAmico R, Gann DS. Hypocalcemia during sepsis. Relationship to resuscitation and hemodynamics. Arch Surg. 1992;127:265-72.
• Referans20 D'Elia JA and Weinrauch LA. Calcium Ion Channels: Roles in Infection and Sepsis Mechanisms of Calcium Channel Blocker Benefits in Immunocompromised Patients at Risk for Infection. Int J Mol Sci. 2018;19:2465.
• Referans21 Malpuech-Brugère C, Nowacki W, Daveau M, Gueux E, Linard C, Rock E, et al. Inflammatory response following acute magnesium deficiency in the rat. Biochim Biophys Acta. 2000;1501:91-8.
• Referans22 Zafar MS, Wani JI, Karim R, Mir MM, Koul PA. Significance of serum magnesium levels in critically ill-patients. Int J Appl Basic Med Res. 2014;4:34-7. Referans23 Miller CJ, Doepker BA, Springer AN, Exline MC, Phillips G, Murphy CV. Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock. J Intensive Care Med. 2020;35:485-493.
• Referans24 Lasky-Su J, Dahlin A, Litonjua AA, Rogers AJ, McGeachie MJ, Baron RM, et al. Metabolome alterations in severe critical illness and vitamin D status. Crit Care. 2017;21:193.
• Referans25 Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770-3.
• Referans26 Amrein K, Papinutti A, Mathew E, Vila G, Parekh D. Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa. Endocr Connect. 2018;7:R304-R315.
• Referans27 Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB. Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit Care Med. 2012;40:63-72.
• Referans28 Anderson PH, Lee AM, Anderson SM, Sawyer RK, O'Loughlin PD, Morris HA. The effect of dietary calcium on 1,25(OH)2D3 synthesis and sparing of serum 25(OH)D3 levels. J Steroid Biochem Mol Biol. 2010;121:288-92.