The clinical significance of vitamin D administration in critically ill patients remains inconclusive. The purpose of this systematic review with meta-analysis was to investigate the effect of vitamin D and its metabolites on major clinical outcomes in critically ill patients, including a subgroup analysis based on vitamin D status and route of vitamin D administration. Major databases were searched through February 9, 2022. Randomized controlled trials of adult critically ill patients with an intervention group receiving vitamin D or its metabolites were included. Random-effect meta-analyses were performed to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Risk of bias assessment included the Cochrane tool for assessing risk of bias in randomized trials. Sixteen randomized clinical trials with 2449 patients were included. Vitamin D administration was associated with lower overall mortality (16 studies: risk ratio 0.78, 95% confidence interval 0.62–0.97, p = 0.03; I2 = 30%), reduced intensive care unit length of stay (12 studies: mean difference − 3.13 days, 95% CI − 5.36 to − 0.89, n = 1250, p = 0.006; I2 = 70%), and shorter duration of mechanical ventilation (9 studies: mean difference − 5.07 days, 95% CI − 7.42 to − 2.73, n = 572, p < 0.0001; I2 = 54%). Parenteral administration was associated with a greater effect on overall mortality than enteral administration (test of subgroup differences, p = 0.04), whereas studies of parenteral subgroups had lower quality. There were no subgroup differences based on baseline vitamin D levels. Vitamin D supplementation in critically ill patients may reduce mortality. Parenteral administration might be associated with a greater impact on mortality. Heterogeneity and assessed certainty among the studies limits the generalizability of the results. Trial registration: PROSPERO international prospective database of systematic reviews (CRD42021256939—05 July 2021).

中文翻译：

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危重成人患者维生素 D 及其代谢物的给药：对随机对照试验进行荟萃分析的最新系统评价

在危重病人中给予维生素 D 的临床意义尚无定论。此项荟萃分析系统评价的目的是调查维生素 D 及其代谢物对危重患者主要临床结局的影响，包括基于维生素 D 状态和维生素 D 给药途径的亚组分析。检索了截至 2022 年 2 月 9 日的主要数据库。纳入了对成人重症患者进行的随机对照试验，其中干预组接受维生素 D 或其代谢物。进行随机效应荟萃分析以估计汇总风险比（二分结果）或平均差（连续结果）。偏倚风险评估包括用于评估随机试验中偏倚风险的 Cochrane 工具。纳入 16 项随机临床试验，共 2449 名患者。维生素 D 给药与较低的总体死亡率相关（16 项研究：风险比 0.78，95% 置信区间 0.62-0.97，p = 0.03；I2 = 30%），减少重症监护病房住院时间（12 项研究：平均差 - 3.13天，95% CI - 5.36 至 - 0.89，n = 1250，p = 0.006；I2 = 70%），机械通气持续时间更短（9 项研究：平均差 - 5.07 天，95% CI - 7.42 至 - 2.73， n = 572，p < 0.0001；I2 = 54%）。与肠内给药相比，肠胃外给药对总死亡率的影响更大（亚组差异检验，p = 0.04），而肠胃外亚组的研究质量较低。基于基线维生素 D 水平没有亚组差异。危重患者补充维生素 D 可降低死亡率。肠胃外给药可能对死亡率有更大的影响。研究之间的异质性和评估的确定性限制了结果的普遍性。试验注册：PROSPERO 国际系统评价前瞻性数据库（CRD42021256939—2021 年 7 月 5 日）。