Association between vitamin D level and dengue severity in children: A prospective study in an Eastern Indian City

Dengue fever, a significant health concern in tropical regions, including India, presents in healthcare settings with a disease spectrum ranging from mild to severe illness. Anti-body dependent enhancement (ADE) and non-ADE mechanism such as nutrition (vitamin D, etc.) have been suggested for dengue severity. The relationship between vitamin D, a known immune modulator, and the severity of dengue fever in pediatric patients was investigated.

This prospective study, enrolled 99 children aged 1-18 years with confirmed dengue fever between April 2023 and September 2024. Patients were classified into dengue fever (DF) or those with complications, including, "Dengue with Warning Signs (DWS) and Severe Dengue (SD)." Serum vitamin D levels were measured at admission, and clinical outcomes and laboratory parameters were analyzed. The ROC curve analysis was used to evaluate vitamin D's ability to predict complications.

Patients having DF with complications, i.e., DWS and SD, had lower vitamin D levels (Median 13.5 ng/ml vs. 21.5 ng/ml) than DF patients. Those with vitamin D levels <20 ng/ml had a 3.3-fold higher risk of complications (p = 0.01). A vitamin D cutoff of 17.9 ng/ml predicted severity with moderate accuracy (AUC = 0.683). Severe cases required longer hospital stays and more intensive care but had full recovery.

Vitamin D deficiency is linked to greater dengue severity in children. Addressing this modifiable risk factor could help reduce severe outcomes, emphasizing the potential role of supplementation in dengue management.