Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients

被引:31
作者
Leaf, David E. [1 ]
Croy, Heather E. [1 ]
Abrahams, Sara J. [1 ]
Raed, Anas [1 ]
Waikar, Sushrut S. [1 ]
机构
[1] Brigham & Womens Hosp, Div Renal Med, Boston, MA 02115 USA
来源
CRITICAL CARE | 2015年 / 19卷
基金
美国国家卫生研究院;
关键词
SERUM 25-HYDROXYVITAMIN D; INTENSIVE-CARE-UNIT; ACUTE KIDNEY INJURY; D-BINDING PROTEIN; LENGTH-OF-STAY; D DEFICIENCY; MINERAL METABOLISM; PEPTIDE; LL-37; MORTALITY;
D O I
10.1186/s13054-015-0812-1
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Decreased production of cathelicidin antimicrobial protein-18 (hCAP18) has been proposed to be a key mechanism linking decreased 25-hydroxyvitamin D (25D) levels with adverse outcomes among critically ill patients. However, few studies in humans have directly assessed plasma hCAP18 levels, and no study has evaluated the association between hCAP18 levels and adverse outcomes among critically ill patients. Methods: We performed a single-center, prospective cohort study among 121 critically ill patients admitted to intensive care units (ICUs) between 2008 and 2012. We measured plasma hCAP18, 25D, D-binding protein, and parathyroid hormone levels on ICU day 1. The primary endpoint was 90-day mortality. Secondary endpoints included hospital mortality, sepsis, acute kidney injury, duration of mechanical ventilation, and hospital length of stay. Results: ICU day 1 hCAP18 levels were directly correlated with 25D levels (Spearman's rho (r(s)) = 0.30, P = 0.001). In multivariate analyses adjusted for age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, patients with hCAP18 levels in the lowest compared to highest tertile on ICU day 1 had a 4.49 (1.08 to 18.67) greater odds of 90-day mortality, and also had greater odds of sepsis. ICU day 1 levels of other analytes were not associated with 90-day mortality. Conclusions: Lower 25D levels on ICU day 1 are associated with lower hCAP18 levels, which are in turn associated with a greater risk of 90-day mortality. These findings provide a potential mechanistic basis for the frequently observed association between low 25D levels and poor outcomes in critically ill patients.
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页数:9
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共 51 条
  • [1] Vitamin D-Directed Rheostatic Regulation of Monocyte Antibacterial Responses
    Adams, John S.
    Ren, Songyang
    Liu, Philip T.
    Chun, Rene F.
    Lagishetty, Venu
    Gombart, Adrian F.
    Borregaard, Niels
    Modlin, Robert L.
    Hewison, Martin
    [J]. JOURNAL OF IMMUNOLOGY, 2009, 182 (07) : 4289 - 4295
  • [2] Effect of High-Dose Vitamin D3 on Hospital Length of Stay in Critically Ill Patients With Vitamin D Deficiency The VITdAL-ICU Randomized Clinical Trial
    Amrein, Karin
    Schnedl, Christian
    Holl, Alexander
    Riedl, Regina
    Christopher, Kenneth B.
    Pachler, Christoph
    Purkart, Tadeja Urbanic
    Waltensdorfer, Andreas
    Muench, Andreas
    Warnkross, Helga
    Stojakovic, Tatjana
    Bisping, Egbert
    Toller, Wolfgang
    Smolle, Karl-Heinz
    Berghold, Andrea
    Pieber, Thomas R.
    Dobnig, Harald
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 312 (15): : 1520 - 1530
  • [3] Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients
    Arnson, Y.
    Gringauz, I.
    Itzhaky, D.
    Amital, H.
    [J]. QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, 2012, 105 (07) : 633 - 639
  • [4] Augmentation of innate host defense by expression of a cathelicidin antimicrobial peptide
    Bals, R
    Weiner, DJ
    Moscioni, AD
    Meegalla, RL
    Wilson, JM
    [J]. INFECTION AND IMMUNITY, 1999, 67 (11) : 6084 - 6089
  • [5] Cathelicidin LL-37 bloodstream surveillance is down regulated during septic shock
    Barbeiro, Denise Frediani
    Barbeiro, Hermes Vieira
    Zampieri, Fernando Godinho
    Cesar Machado, Marcel Cerqueira
    Torggler Filho, Francisco
    Gomes Cunha, Debora Maria
    Goulart, Alessandra Carvalho
    Velasco, Irineu Tadeu
    da Cruz Neto, Luiz Monteiro
    de Souza, Heraldo Possolo
    da Silva, Fabiano Pinheiro
    [J]. MICROBES AND INFECTION, 2013, 15 (05) : 342 - 346
  • [6] Antiviral Activity and Increased Host Defense against Influenza Infection Elicited by the Human Cathelicidin LL-37
    Barlow, Peter G.
    Svoboda, Pavel
    Mackellar, Annie
    Nash, Anthony A.
    York, Ian A.
    Pohl, Jan
    Davidson, Donald J.
    Donis, Ruben O.
    [J]. PLOS ONE, 2011, 6 (10):
  • [7] Bergman P, 2007, CURR HIV RES, V5, P410
  • [8] Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients
    Bhan, Ishir
    Powe, Camille E.
    Berg, Anders H.
    Ankers, Elizabeth
    Wenger, Julia B.
    Karumanchi, S. Ananth
    Thadhani, Ravi I.
    [J]. KIDNEY INTERNATIONAL, 2012, 82 (01) : 84 - 89
  • [9] Circulating levels of 25-hydroxyvitamin D and human cathelicidin in healthy adults
    Bhan, Ishir
    Camargo, Carlos A., Jr.
    Wenger, Julia
    Ricciardi, Catherine
    Ye, Jun
    Borregaard, Niels
    Thadhani, Ravi
    [J]. JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2011, 127 (05) : 1302 - 1304
  • [10] ASSESSMENT OF THE FREE FRACTION OF 25-HYDROXYVITAMIN-D IN SERUM AND ITS REGULATION BY ALBUMIN AND THE VITAMIN-D-BINDING PROTEIN
    BIKLE, DD
    GEE, E
    HALLORAN, B
    KOWALSKI, MA
    RYZEN, E
    HADDAD, JG
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1986, 63 (04) : 954 - 959