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Vitamin D deficiency and acute vaso-occlusive complications in children with sickle cell disease
Margaret T Lee1, Maureen Licursi, Donald J McMahon
1Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York.
Insights
Vitamin D deficiency is common in children with sickle cell disease (SCD). Low vitamin D levels are associated with increased acute pain episodes in children with SCD, suggesting a potential intervention.
Area of Science:
- Pediatric Hematology
- Nutritional Science
- Public Health
Background:
- Sickle cell disease (SCD) is associated with a high prevalence of vitamin D deficiency.
- Limited data exist on the link between low vitamin D and acute vaso-occlusive complications in SCD patients.
- This study investigates the association between vitamin D deficiency and acute pain and acute chest syndrome (ACS) in children with SCD.
Purpose of the Study:
- To examine the association between vitamin D deficiency and acute pain.
- To investigate the association between vitamin D deficiency and acute chest syndrome (ACS).
- To determine if low vitamin D levels correlate with vaso-occlusive complications in pediatric SCD patients.
Main Methods:
- A cross-sectional study involved 95 children with SCD.
- Serum 25-hydroxyvitamin D (25-OHD) levels were measured.
- Logistic regression analyzed associations between 25-OHD levels and acute pain/ACS, with odds ratios calculated for vitamin D deficiency (25-OHD <20 ng/ml).
Main Results:
- The median 25-OHD level was 16 ng/ml, with 59% of participants being vitamin D-deficient.
- Serum 25-OHD levels were significantly associated with acute pain (P=0.0121) but not with ACS (P=0.628).
- Vitamin D deficiency was linked to a 2.7-fold increased risk of acute pain (OR=2.7, 95% CI=1.05-6.94).
Conclusions:
- Vitamin D deficiency is highly prevalent in children with SCD.
- Low vitamin D levels show a potential association with acute pain crises in pediatric SCD.
- Supplementing vitamin D may be a simple, cost-effective strategy to mitigate vaso-occlusive events in SCD.
Background:
Vitamin D is increasingly recognized for its roles in non-skeletal disorders. Patients with sickle cell disease (SCD) have a high prevalence of vitamin D deficiency but data are limited with respect to possible associations between low vitamin D and acute vaso-occlusive complications. We examined whether vitamin D deficiency is associated with acute pain and acute chest syndrome (ACS) in children with SCD.
Procedure:
A cross-sectional study was conducted in 95 children with SCD who had serum 25-hydroxyvitamin D (25-OHD) measured during comprehensive care examinations. History of acute pain and ACS within two years of obtaining 25-OHD was collected. Associations between 25-OHD levels and acute vaso-occlusive events were analyzed by logistic regression. Odds ratios and 95% confidence intervals were calculated for the risk of pain and ACS associated with vitamin D deficiency (25-OHD <20 ng/ml).
Results:
Subjects were 3-20 years old (median 10.6); 48 males, 47 females; 46 African, 49 Hispanic; 72 SS, 20 SC, 1 S/β(0) Thalassemia, and 2 S/β(+) Thalassemia. Median 25-OHD was 16 ng/ml. Fifty-six (59%) were vitamin D-deficient. Thirty-one (33%) and 29 (31%) had at least one episode of pain and ACS, respectively. Serum 25-OHD was significantly associated with pain (P = 0.0121) but not with ACS (P = 0.628). Of those with pain, 73% (23/31) were vitamin D-deficient while 26% (8/31) had 25-OHD ≥20 ng/ml (P = 0.04, OR = 2.7, 95%CI = 1.05-6.94).
Conclusions:
Our findings emphasize the high prevalence of vitamin D deficiency and its potential association with acute pain in SCD. Correcting low vitamin D may offer a simple, low-cost intervention to help reduce acute vaso-occlusive complications.
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