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Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study
Payal Kubsad1, S R Ravikiran1, Kamalakshi G Bhat1
1Department of Pediatrics, Kasturba Medical College, Mangaluru, Karnataka, India.
Insights
Critically ill children with sepsis frequently have vitamin D deficiency, impacting parathyroid hormone (PTH) response. This study found impaired PTH response in these children, highlighting a significant health concern.
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Nutritional science
Background:
- Critically ill Indian children exhibit a high prevalence of vitamin D deficiency.
- Limited data exists on vitamin D status and parathyroid hormone (PTH) response in pediatric sepsis.
- Previous research suggests impaired PTH response to vitamin D deficiency in critically ill populations.
Purpose of the Study:
- To investigate the prevalence of hypovitaminosis D in critically ill children with sepsis.
- To analyze the parathyroid hormone (PTH) response to vitamin D deficiency in this subgroup.
- To compare vitamin D and PTH levels between septic children and controls.
Main Methods:
- A case-control study involving 84 critically ill children with sepsis (cases) and 84 controls.
- Measurement of vitamin D and PTH levels between November 2018 and February 2020.
- Definition of hypovitaminosis D as vitamin D levels <30 ng/mL.
Main Results:
- Higher prevalence of hypovitaminosis D (79.7%) in septic children compared to controls (9.5%).
- Impaired parathyroid hormone (PTH) response observed in 86.2% of septic children with hypovitaminosis D.
- No significant differences in mortality, PICU stay, or disease severity between vitamin D sufficient/deficient or PTH responder/non-responder groups.
Conclusions:
- Hypovitaminosis D is significantly more prevalent in critically ill children with sepsis.
- Critically ill children with sepsis demonstrate an impaired parathyroid gland response to vitamin D deficiency.
- Further research is needed to explore the clinical implications of impaired PTH response in pediatric sepsis.
Abstract:
Background: Critically ill Indian children have a higher prevalence of vitamin D deficiency. However, there is not much data available on the subgroup with sepsis. It has been reported that there is an impaired response of parathyroid hormone (PTH) to vitamin D deficiency in critically ill children and adults. Hence, we also sought to analyze the PTH response to vitamin D among the subgroup of critically ill children with sepsis. Patients and methods: Vitamin D and PTH levels of 84 critically ill children with sepsis (cases) and 84 controls were compared between November 2018 and February 2020. Hypovitaminosis D was defined as levels <30 ng/mL. Results: The median (IQR) of vitamin D for cases was 26 (21.30-29.95) ng/mL and that for controls 39.3 (33.65-50.2) ng/mL; p <0.001. Cases had a higher prevalence of hypovitaminosis D as compared to controls (79.7 vs 9.5%; p <0.001). Among the cases, mortality was 24.6% in the 65 children with hypovitaminosis D and 10.5% in those with sufficient vitamin D; the differences were not statistically significant (p = 0.339). There were no significant differences in the duration of pediatric intensive care unit (PICU) stay, serum calcium, PTH, and disease severity among the aforementioned groups. Out of the 65 children with hypovitaminosis D, only 9 (13.8%) were PTH responders. There were no statistically significant differences in mortality, the PICU stay, or disease severity at admission between PTH responders and nonresponders. Conclusions: Hypovitaminosis D was more prevalent among critically ill children with sepsis compared to controls. Parathyroid gland response to hypovitaminosis D was impaired in children with sepsis. How to cite this article: Kubsad P, Ravikiran SR, Bhat KG, Kamath N, Kulkarni V, Manjrekar PA, et al. Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study. Indian J Crit Care Med 2021;25(8):923-927.
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