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Serum Vitamin D Status and Outcome among Critically Ill Children Admitted to the Pediatric Intensive Care Unit in South India

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Abstract

Objectives

To determine the vitamin D status and the association between vitamin D status and the clinical outcome of critically ill children admitted to pediatric intensive care unit (PICU) in South India.

Methods

Fifty-four consecutive children with medical and surgical diagnoses were included with parental consent. Severity of illness was assessed using PIM-2 score; Sequential Organ Failure Assessment Cardiovascular Score (CV-SOFA) was used to describe vasopressor use. Serum for 25(OH) D levels was obtained as close as possible to the ICU admission. Vitamin D deficiency was defined as serum 25(OH) D level < 20 ng/ml (50 nmol/L). Primary outcome measures were serum 25(OH) D level and in-hospital all cause mortality. Secondary outcomes were illness severity, vasopressor requirement, use of mechanical ventilation and duration of ICU stay.

Results

Of the 54 children, two were excluded due to insufficient serum for vitamin D analysis. Median age was 17.5 mo (IQR = 4.5–78); 38.5 % were infants. Higher age was associated with low vitamin D levels (r s  = −0.34; p 0.01). Median serum 25(OH) D level was 25.1 ng/ml (IQR = 16.2–34.2). Shock (30.8 %), CNS conditions (23.1 %) and respiratory illnesses (21.2 %) were the three most common reasons for admission to the PICU. Vitamin D deficiency was seen in 40.3 % of the critically ill children. Higher PIM score or SOFA score were associated with low vitamin levels (r s  = −0.29, p 0.04 and r s  = −0.29, p 0.05 respectively). Children who were mechanically ventilated had a significantly lower median serum 25(OH) D level than those who were not on ventilation [19.5 ng/ml (IQR = 14.6–27.7)] vs. 32.1 ng/ml[(IQR = 16.5–50.9), p 0.01]. Serum 25(OH) D level was also positively associated with serum calcium levels (r s  = 0.32, p 0.03). The proportion of children who died or were discharged terminally at parental request was 23.8 % among those with serum 25(OH) D level <20 ng/ml as compared to 16.1 % among those with serum 25(OH) D level >20 ng/ml (p 0.49).

Conclusions

Vitamin D deficiency is common among pediatric patients admitted to PICU in South India. Low serum 25(OH) D level was associated with higher severity of illness, need for mechanical ventilation, more vasopressor use and lower serum calcium levels. No association between vitamin D status and mortality was demonstrated.

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References

  1. Rathi N, Rathi A. Vitamin D and child health in the 21st century. Indian Pediatr. 2011;48:619–25.

    Article  PubMed  Google Scholar 

  2. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.

    Article  CAS  PubMed  Google Scholar 

  3. Lee P, Nair P, Eisman JA, Center JR. Vitamin D deficiency in the intensive care unit: an invisible accomplice to morbidity and mortality? Intensive Care Med. 2009;35:2028–32.

    Article  CAS  PubMed  Google Scholar 

  4. Lee P, Eisman JA, Center JR. Vitamin D deficiency in critically ill patients. N Engl J Med. 2009;360:1912–4.

    Article  CAS  PubMed  Google Scholar 

  5. Braun A, Chang D, Mahadevappa K, et al. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med. 2011;39:671–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. J Parenter Enteral Nutr. 2012;36:713–20.

    Article  CAS  Google Scholar 

  7. Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg. 2012;204:37–43.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Arnson Y, Gringauz I, Itzhaky D, Amital H. Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM. 2012;105:633–9.

    Article  CAS  PubMed  Google Scholar 

  9. Rey C, S’anchez-Arango D, Lopez-Herce J, et al. Vitamin D deficiency at paediatric intensive care admission. J Pediatr. 2014;90:135–42.

    Article  Google Scholar 

  10. Rippel C, South M, Butt WW, Shekerdemian LS. Vitamin D status in critically ill children. Intensive Care Med. 2012;38:2055–62.

    Article  CAS  PubMed  Google Scholar 

  11. McNally JD, Menon K, Chakraborty P, et al; On behalf of the Canadian Critical Care Trials Group. The association of vitamin D status with pediatric critical illness. Pediatrics. 2012;130:429–36.

  12. Madden K, Feldman HA, Smith EM, et al. Vitamin D deficiency in critically ill children. Pediatrics. 2012;130:421–8.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Tiwari L, Puliyel JM. Vitamin D level in slum children of Delhi. Indian Pediatr. 2004;41:1076–7.

    PubMed  Google Scholar 

  14. Marwaha RK, Tandon N, Reddy DR, et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr. 2005;82:477–82.

    CAS  PubMed  Google Scholar 

  15. Puri S, Marwaha RK, Agarwal N, et al. Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr. 2008;99:876–82.

    Article  CAS  PubMed  Google Scholar 

  16. Joshi K, Bhatia V. Vitamin D deficiency in a tropical country-treatment and prevention in children. Indian J Pediatr. 2014;81:84–9.

    Article  PubMed  Google Scholar 

  17. Yadav M, Mittal K. Effect of vitamin D supplementation on moderate to severe bronchial asthma. Indian J Pediatr. 2014;81:650–4.

    Article  PubMed  Google Scholar 

  18. Agarwal DK, Agarwal KN. Physical growth of affluent Indian children. Indian Pediatr. 1994;31:377–413.

    CAS  PubMed  Google Scholar 

  19. Agarwal DK, Agarwal KN, Upadhyay SK, Mittal R, Prakash R, Rai S. Physical and sexual growth pattern of affluent Indian children from 5 to 18 years of age. Indian Pediatr. 1992;29:1203–82.

    CAS  PubMed  Google Scholar 

  20. Slater A, Shann F, Pearson G; Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the paediatric index of mortality. Intensive Care Med. 2003;29:278–85.

  21. Vincent JL, de Mendonça A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. working group on “sepsis-related problems” of the european society of intensive care medicine. Crit Care Med. 1998;26:1793–800.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. Kempker JA, Tangpricha V, Ziegler TR, Martin GS. Vitamin D in sepsis: from basic science to clinical impact. Crit Care. 2012;16:316–21.

    Article  PubMed Central  PubMed  Google Scholar 

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Contributions

KE: Designed the project, supervised patient care, was responsible for data collection & data management and drafted the manuscript; VJ: Performed the vitamin D assay; BA: Completed the statistical analysis; MN: Involved in patient care and assisted in data collection; AD and MS: Provided intellectual support for the conception of the study and critically reviewed the manuscript. KE will act as guarantor for this paper.

Conflict of Interest

None.

Source of Funding

Fluid Research Fund, Christian Medical College, Vellore.

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Authors and Affiliations

  1. Department of Pediatrics, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Kala Ebenezer & M. N. Manivachagan

  2. Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India

    Victoria Job

  3. Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

    Belavendra Antonisamy

  4. Global Health Centre, Cincinnati Children’s Medical Centre, Cincinnati, OH, USA

    Adekunle Dawodu & Mark Steinhoff

Authors
  1. Kala Ebenezer
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  2. Victoria Job
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  3. Belavendra Antonisamy
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  4. Adekunle Dawodu
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  5. M. N. Manivachagan
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  6. Mark Steinhoff
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Correspondence to Kala Ebenezer.

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Ebenezer, K., Job, V., Antonisamy, B. et al. Serum Vitamin D Status and Outcome among Critically Ill Children Admitted to the Pediatric Intensive Care Unit in South India. Indian J Pediatr 83, 120–125 (2016). https://doi.org/10.1007/s12098-015-1833-0

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  • DOI: https://doi.org/10.1007/s12098-015-1833-0

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