Vitamin D deficiency and morbimortality in critically ill paediatric patients

Abstract

Abstract Objectives To determine the prevalence and risks factors of vitamin D deficiency, as well as its relationship with morbidity and mortality in a PICU. Materials 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 48 h 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 = 0.039), had parents with a higher level of academic studies (36.5% vs 20%, P = 0.016), were admitted more often in winter and spring, had a higher PRISM-III (6.8 vs 5.1, P = 0.037), a longer PICU stay (3 vs 2 days, P = 0.001), and higher morbidity (61.1% vs 30.4%, P P = 0.012). 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.