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Association between circulating 25-hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta-analysis.
Int J Rheum Dis. 2019 Oct; 22(10):1803-1813.IJ

Abstract

AIM

The indicators for measuring vitamin D are various, and 25-hydroxyvitamin D (25(OH)D) is considered as the optimal indicator of total vitamin D levels. In this study, we aim to deeply explore the 25(OH)D status in systemic lupus erythematosus (SLE) patients, and evaluate its relation to SLE risk and disease severity.

METHODS

Literature about 25(OH)D status and its associations with SLE were searched in Pubmed, Embase and Cochrane Library databases. Standardized mean difference (SMD), odds ratio (OR) and corresponding 95% confidence interval (95% CI) were illustrated by forest plots, and correlation coefficients (r) were combined by generic inverse variance method. Heterogeneity and publication bias were quantified by I-squared (I2) test, funnel plot and Egger's test, respectively. Sensitivity analyses were further examined by leave-one-out method.

RESULTS

Nineteen articles were included into our meta-analysis. The overall results showed that compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in SLE patients (pooled SMD = -1.63, 95% CI: -2.51 to -0.76). Subgroup analysis revealed that compared with the healthy controls, SLE patients of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) ≥ 10, Arab and European ethnicity, all 4 seasons, no vitamin D supplement, had significantly lower circulating 25(OH)D levels; no significant differences were observed in SLE patients of SLEDAI < 10, mixed ethnicity, spring, summer, vitamin D supplement, respectively; no matter the changes of age, disease duration, and the therapy of corticosteroid or immunosuppressive or neither, circulating 25(OH)D levels were significantly reduced in SLE patients. The deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease (not significantly), significantly decrease SLE risk, respectively (pooled OR = 4.37, 95% CI: 1.49 to 12.84; pooled OR = 0.52, 95% CI: 0.22 to 1.26; pooled OR = 0.31, 95% CI: 0.15 to 0.63). Circulating 25(OH)D levels were inversely associated with SLEDAI (pooled correlation coefficient = -0.50, 95% CI: -0.8278 to -0.1689).

CONCLUSIONS

Compared with healthy controls, 25(OH)D levels are significantly lower in SLE patients, which is influenced by disease activity, ethnicity, seasons and vitamin D supplement; no matter the change of age, diseases duration and therapy of corticosteroid or immunosuppressive or neither, 25(OH)D levels are significantly decreased in SLE patients; the deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease, and significantly decrease SLE risk, respectively; and 25(OH)D levels inversely correlate with SLEDAI.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Preventive Health, Chaohu Hospital of Anhui Medical University, Chaohu, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31468723

Citation

Guan, Shi-Yang, et al. "Association Between Circulating 25-hydroxyvitamin D and Systemic Lupus Erythematosus: a Systematic Review and Meta-analysis." International Journal of Rheumatic Diseases, vol. 22, no. 10, 2019, pp. 1803-1813.
Guan SY, Cai HY, Wang P, et al. Association between circulating 25-hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta-analysis. Int J Rheum Dis. 2019;22(10):1803-1813.
Guan, S. Y., Cai, H. Y., Wang, P., Lv, T. T., Liu, L. N., Mao, Y. M., Zhao, C. N., Wu, Q., Dan, Y. L., Sam, N. B., Wang, D. G., & Pan, H. F. (2019). Association between circulating 25-hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta-analysis. International Journal of Rheumatic Diseases, 22(10), 1803-1813. https://doi.org/10.1111/1756-185X.13676
Guan SY, et al. Association Between Circulating 25-hydroxyvitamin D and Systemic Lupus Erythematosus: a Systematic Review and Meta-analysis. Int J Rheum Dis. 2019;22(10):1803-1813. PubMed PMID: 31468723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between circulating 25-hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta-analysis. AU - Guan,Shi-Yang, AU - Cai,Hong-Yan, AU - Wang,Peng, AU - Lv,Tian-Tian, AU - Liu,Li-Na, AU - Mao,Yan-Mei, AU - Zhao,Chan-Na, AU - Wu,Qian, AU - Dan,Yi-Lin, AU - Sam,Napoleon Bellua, AU - Wang,De-Guang, AU - Pan,Hai-Feng, Y1 - 2019/08/30/ PY - 2019/02/26/received PY - 2019/06/16/revised PY - 2019/07/15/accepted PY - 2019/8/31/pubmed PY - 2020/4/9/medline PY - 2019/8/31/entrez KW - 25-hydroxyvitamin D KW - meta-analysis KW - systemic lupus erythematosus KW - vitamin D SP - 1803 EP - 1813 JF - International journal of rheumatic diseases JO - Int J Rheum Dis VL - 22 IS - 10 N2 - AIM: The indicators for measuring vitamin D are various, and 25-hydroxyvitamin D (25(OH)D) is considered as the optimal indicator of total vitamin D levels. In this study, we aim to deeply explore the 25(OH)D status in systemic lupus erythematosus (SLE) patients, and evaluate its relation to SLE risk and disease severity. METHODS: Literature about 25(OH)D status and its associations with SLE were searched in Pubmed, Embase and Cochrane Library databases. Standardized mean difference (SMD), odds ratio (OR) and corresponding 95% confidence interval (95% CI) were illustrated by forest plots, and correlation coefficients (r) were combined by generic inverse variance method. Heterogeneity and publication bias were quantified by I-squared (I2) test, funnel plot and Egger's test, respectively. Sensitivity analyses were further examined by leave-one-out method. RESULTS: Nineteen articles were included into our meta-analysis. The overall results showed that compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in SLE patients (pooled SMD = -1.63, 95% CI: -2.51 to -0.76). Subgroup analysis revealed that compared with the healthy controls, SLE patients of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) ≥ 10, Arab and European ethnicity, all 4 seasons, no vitamin D supplement, had significantly lower circulating 25(OH)D levels; no significant differences were observed in SLE patients of SLEDAI < 10, mixed ethnicity, spring, summer, vitamin D supplement, respectively; no matter the changes of age, disease duration, and the therapy of corticosteroid or immunosuppressive or neither, circulating 25(OH)D levels were significantly reduced in SLE patients. The deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease (not significantly), significantly decrease SLE risk, respectively (pooled OR = 4.37, 95% CI: 1.49 to 12.84; pooled OR = 0.52, 95% CI: 0.22 to 1.26; pooled OR = 0.31, 95% CI: 0.15 to 0.63). Circulating 25(OH)D levels were inversely associated with SLEDAI (pooled correlation coefficient = -0.50, 95% CI: -0.8278 to -0.1689). CONCLUSIONS: Compared with healthy controls, 25(OH)D levels are significantly lower in SLE patients, which is influenced by disease activity, ethnicity, seasons and vitamin D supplement; no matter the change of age, diseases duration and therapy of corticosteroid or immunosuppressive or neither, 25(OH)D levels are significantly decreased in SLE patients; the deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease, and significantly decrease SLE risk, respectively; and 25(OH)D levels inversely correlate with SLEDAI. SN - 1756-185X UR - https://www.unboundmedicine.com/medline/citation/31468723/Association_between_circulating_25_hydroxyvitamin_D_and_systemic_lupus_erythematosus:_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/1756-185X.13676 DB - PRIME DP - Unbound Medicine ER -