Effect Of Vitamin D Level In VAP Patients On Immune Function And Prognosis Factors

Objective:Vitamin D plays an important role in host defense and is associated with prognosis of patients in intensive care unit(ICU).In this paper,through the detection of serum vitamin D levels,VAP patients with vitamin D levels on immune function and prognostic factors.Methods: From July 2017 to January 2018,40 patients diagnosed with VAP and 20 healthy volunteers admitted to Shengjing Hospital Intensive Care Unit(ICU)of China Medical University were prospectively studied.25(OH)D and T lymphocyte count were measured in healthy volunteers.The 25(OH)D,T lymphocyte count,PCT and CRP were also measured in patients with VAP at the same time.APACHE II score,SOFA score and CPIS score,and followed up to 28 days.The outcome of 28 days of patients as the end point,divided into survival group and death group;healthy volunteers as a healthy control group.The immune function of VAP patients and the risk factors affecting the prognosis of patients with VAP were analyzed.The levels of 25(OH)D and clinical data were compared between the survival and death groups.Results: Forty VAP patients had vitamin D deficiency.The levels of T lymphocyte and 25(OH)D in peripheral blood of death group and survival group were lower than those of healthy group(P <0.05).The levels of T lymphocyte and 25(OH)D in death group were lower than those in healthy group In survival group,the difference was statistically significant(P <0.05).Vitamin D in VAP patients was lower in patients with diabetes(p = 0.023);vitamin D levels were lower in patients with cerebrovascular disease(p = 0.034).The SOFA score in the death group was higher than that in the survival group(P = 0.002).The PCT in the death group was higher than that in the survival group(P = 0.00).Vitamin D level was negatively correlated with CPIS score(r =-0.324,p = 0.041);SOFA score(r=-0.436,p = 0.005);vitamin D level was negatively correlated with PCT level(r=-0.555,p = 0.000).When severe vitamin D deficiency(25(OH)D ?10 ng / m L),SOFA score increased(p = 0.047)and procalcitonin levels significantly increased(p = 0.004).Vitamin D levels were significantly lower in survivors than in survivors(P = 0.001).Multivariate analysis showed that the risk of death from vitamin D status stratification 25(OH)D ? 10 ng / m L(n = 24)was 15.321 times the risk of death from 25(OH)D> 10 ng / m L.Conclusion: VAP patients generally lack of vitamin D,and there is immune dysfunction.Vitamin D status stratification can independently predict prognosis,have a significant impact on prognosis,is an important predictor of 28-day mortality.