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[Vitamin D deficiency and morbimortality in critically ill paediatric patients]
Patricia García-Soler1, Antonio Morales-Martínez1, Vanessa Rosa-Camacho1
1Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario de Málaga, Málaga, España.
Insights
Vitamin D deficiency is common in critically ill children, affecting 43.8% of patients. This deficiency is linked to increased morbidity and mortality in the pediatric intensive care unit (PICU).
Area of Science:
- Pediatric critical care medicine
- Nutritional deficiencies
- Biomarkers of critical illness
Background:
- Vitamin D plays a crucial role in immune function and overall health.
- Deficiency is a growing concern in various patient populations, including critically ill children.
- Understanding vitamin D status in the PICU is essential for optimizing patient outcomes.
Purpose of the Study:
- To determine the prevalence of vitamin D deficiency in critically ill children.
- To identify risk factors associated with vitamin D deficiency in this population.
- To investigate the relationship between vitamin D deficiency, morbidity, and mortality in the PICU.
Main Methods:
- An observational prospective study was conducted in a tertiary children's University Hospital PICU.
- The study included 340 critically ill children aged 6 months to 16 years.
- 25-hydroxyvitamin D [25(OH)D] levels were measured within 48 hours of admission, along with other clinical and laboratory parameters.
Main Results:
- The overall prevalence of vitamin D deficiency was 43.8%.
- Vitamin D deficient patients were older, had parents with higher academic studies, and were admitted more often in winter/spring.
- Deficiency was associated with higher PRISM-III scores, longer PICU stays, increased morbidity (OR 5.44), and higher mortality.
Conclusions:
- Vitamin D deficiency is frequent in critically ill children admitted to the PICU.
- The deficiency is significantly related to increased morbidity and mortality.
- Further research is needed to clarify if this relationship is causal or a marker of disease severity.
Objectives:
To determine the prevalence and risks factors of vitamin D deficiency, as well as its relationship with morbidity and mortality in a PICU.
Material And Methods:
An observational prospective study in a tertiary children's University Hospital PICU conducted in two phases: i: cohorts study, and ii: prevalence study. The study included 340 critically ill children with ages comprising 6 months to 16 years old.
Exclusion Criteria:
Chronic kidney disease, known parathyroid disorders, and vitamin D supplementation. Total 25-hydroxyvitamin D [25(OH)D] was measured in the first 48hours of admission to a PICU. Parathormone, calcium, phosphate, blood gases, blood count, C-reactive protein, and procalcitonin were also analysed. A record was also made of demographic features, characteristics of the episode, and complications during the PICU stay.
Results:
The overall prevalence rate of vitamin D deficiency was 43.8%, with a mean of 22.28 (95% CI 21.15-23.41) ng/ml. Patients with vitamin D deficiency were older (61 vs 47 months, P=.039), had parents with a higher level of academic studies (36.5% vs 20%, P=.016), were admitted more often in winter and spring, had a higher PRISM-III (6.8 vs 5.1, P=.037), a longer PICU stay (3 vs 2 days, P=.001), and higher morbidity (61.1% vs 30.4%, P<001) than the patients with sufficient levels of 25(OH)D. Patients who died had lower levels of 25(OH)D (14±8.81ng/ml versus 22.53±10.53ng/ml, P=.012). Adjusted OR for morbidity was 5.44 (95%CI; 2.5-11.6).
Conclusions:
Vitamin D deficiency is frequent in critically ill children, and it is related to both morbidity and mortality, although it remains unclear whether it is a causal relationship or it is simply a marker of severity in different clinical situations.
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