PEDIATRICS / CLINICAL RESEARCH
An observational study of serum vitamin D status in critically ill children admitted to the pediatric intensive care unit
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Department of Pediatrics, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Turkey
Submission date: 2022-08-02
Final revision date: 2022-10-03
Acceptance date: 2022-10-03
Online publication date: 2022-10-06
Corresponding author
Nilay Gunes
Department of Pediatrics, Cerrahpaşa Medical Faculty, Istanbul University-
Cerrahpaşa, Istanbul, Turkey
Arch Med Sci 2025;21(2):471-477
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ABSTRACT
Introduction:
Vitamin D is a pleiotropic hormone involved in the functioning of organ systems including those central to critical illness pathophysiology. We evaluated the longitudinal vitamin D status in the pediatric intensive care unit (PICU) and its relevance to patient outcomes.
Material and methods:
Thirty-six PICU-admitted patients and 40 age- and sex-matched healthy children were enrolled. Serum total 25-hydroxyvitamin D [25(OH)D] levels were analyzed on PICU days 1, 5, and 10 in the patient group, and once in the control group. Patients were divided into sufficient (> 30 ng/ml), insufficient (20–30 ng/ml), and deficient (< 20 ng/ml) subgroups. Outcome measures between the subgroups and alterations in 25(OH)D levels were examined.
Results:
The mean 25(OH)D levels of PICU patients initially and control cases were not different (25.4 ±6.0 and 25.9 ±5.8 ng/ml, respectively). Although all patients with vitamin D deficiency were hospitalized for infectious diseases, the mean 25(OH)D level of patients hospitalized for infections was not different from other patients. There was no difference between vitamin D subgroups in demographic variables, admission season, illness severity, respiratory/inotropic support, duration of stay, or mortality. Vitamin D deficient patients had lower albumin concentrations (p < 0.05). On days 5 and 10, the mean 25(OH)D levels of the patients were 24.5 ±5.7 and 23.6 ±5.8 ng/ml, respectively, both different from the admission level (p < 0.001).
Conclusions:
Hypovitaminosis D, which is common in healthy children, is also common in PICU admission and tends to be more profound during the stay. Further studies are required to evaluate the bioavailability of vitamin D in critical illness.
REFERENCES (26)
1.
Amrein K, Scherkl M, Hoffmann M, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr 2020; 74: 1498-513.
2.
McNally JD, Nama N, O’Hearn K, et al. Vitamin D deficiency in critically ill children: a systematic review and meta-analysis. Crit Care 2017; 21: 287.
3.
Amrein K, Venkatesh B. Vitamin D and the critically ill patient. Curr Opin Clin Nutr Metab Care 2012; 15: 188-93.
4.
Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 2011; 25: 769-81.
5.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-30.
6.
Cashman KD, Dowling KG, Skrabakova Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 2016; 103: 1033-44.
7.
Yesiltepe-Mutlu G, Aksu ED, Bereket A, Hatun S. Vitamin D status across age groups in Turkey: results of 108,742 samples from a single laboratory. J Clin Res Pediatr Endocrinol 2020; 12: 248-55.
8.
Wang L, Zhang C, Song Y, Zhang Z. Serum vitamin D deficiency and risk of gestational diabetes mellitus: a meta-analysis. Arch Med Sci 2020; 16: 742-51.
9.
de Haan K, Groeneveld AB, de Geus HR, Egal M, Struijs A. Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit Care 2014; 18: 660.
10.
He M, Cao T, Wang J, Wang C, Wang Z, Abdelrahim MEA. Vitamin D deficiency relation to sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and duration of mechanical ventilation in critically ill children: a meta-analysis. Int J Clin Pract 2021; 75: e13908.
11.
Ben-Eltriki M, Hopefl R, Wright JM, Deb S. Association between vitamin D status and risk of developing severe COVID-19 infection: a meta-analysis of observational studies. J Am Coll Nutr 2022; 41; 679-89.
12.
Cariolou M, Cupp MA, Evangelou E, Tzoulaki I, Berlanga-Taylor AJ. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis. BMJ Open 2019; 9: e027666.
13.
Jhang WK, Kim DH, Park SJ. Association of vitamin D deficiency with clinical outcomes in critically ill Korean children. Nutr Res Pract 2020; 14: 12-9.
14.
Madden K, Feldman HA, Smith EM, et al. Vitamin D deficiency in critically ill children. Pediatrics 2012; 130: 421-8.
15.
Dohain AM, Almogati J, Al-Radi OO, et al. Serum vitamin D status following pediatric cardiac surgery and association with clinical outcome. Eur J Pediatr 2020; 179: 635-43.
16.
McNally JD, Menon K, Chakraborty P, et al. Impact of anesthesia and surgery for congenital heart disease on the vitamin D status of infants and children: a prospective longitudinal study. Anesthesiology 2013; 119: 71-80.
17.
Reid D, Toole BJ, Knox S, et al. The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty. Am J Clin Nutr 2011; 93: 1006-11.
18.
Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr 2012; 36: 713-20.
19.
De Leon AL, Romero-Gutierrez G, Valenzuela CA, Gonzalez-Bravo FE. Simplified PRISM III score and outcome in the pediatric intensive care unit. Pediatr Int 2005; 47: 80-3.
20.
Leteurtre S, Martinot A, Duhamel A, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003; 362: 192-7.
21.
Hebbar KB, Wittkamp M, Alvarez JA, McCracken CE, Tangpricha V. Vitamin D deficiency in pediatric critical illness. J Clin Transl Endocrinol 2014; 1: 170-5.
22.
Rey C, Sanchez-Arango D, Lopez-Herce J, et al. Vitamin D deficiency at pediatric intensive care admission. J Pediatr 2014; 90: 135-42.
23.
Jassil NK, Sharma A, Bikle D, Wang X. Vitamin D Binding protein and 25-hydroxyvitamin D levels: emerging clinical applications. Endocr Pract 2017; 23: 605-13.
24.
Madden K, Feldman HA, Chun RF, et al. Critically ill children have low vitamin D-binding protein, influencing bioavailability of vitamin D. Ann Am Thorac Soc 2015; 12: 1654-61.
25.
Blomberg Jensen M, Husted H, Bjerrum PJ, Juul A, Kehlet H. Compromised activation of vitamin D after elective surgery: a prospective pilot study. JBMR Plus 2018; 2: 281-8.
26.
Farrell CJ, Martin S, McWhinney B, Straub I, Williams P, Herrmann M. State-of-the-art vitamin D assays: a comparison of automated immunoassays with liquid chromatography-tandem mass spectrometry methods. Clin Chem 2012; 58: 531-42.