Research Update: The association of vitamin D status with pediatric critical illness

Inadequate vitamin D has been thought to predispose to or worsen critical illness pathophysiology. This recent study has provided evidence, for the first time, that vitamin D deficiency is both common among critically ill children and associated with greater severity of critical illness.

The objective of this research, published in the journal Pediatrics (September 2012), was to determine the prevalence and risk factors of vitamin D deficiency among critically ill children, and to explore its relationship with clinically important outcomes. This study was a secondary analysis of information gathered as part of a multicentre prospective cohort study conducted in tertiary-care PICUs in Canada. Data for 326 children up to 17 years of age were available for analysis in this vitamin D sub-study. Nearly all the blood samples used were collected within 24 hours of admission.

The prevalence of vitamin D deficiency (defined as 25(OH)D concentration of less than 50 nmol/L) was found to be at 69%. Further evaluation revealed that for each additional point of the Pediatric Risk of Mortality (PRISM) score, the likelihood of being vitamin D deficient increased by 8% (p=0.005). Significantly lower levels of 25(OH)D were observed in subgroups requiring intubation and catecholamine infusion, as well as subjects with hypocalcemia. Multivariate regression analysis showed that vitamin D deficiency was independently associated with a longer length of stay in PICU (an extra 1.92 days; p=0.03) – every 10 nmol/L decrease in the level of 25(OH)D was associated with 0.44 additional days.

This is the largest study to date reporting 25(OH)D levels in critically ill patients. The authors acknowledged that the concentrations measured may not accurately represent the pre-illness state, since both disease and treatment interventions may reduce serum levels. Subsequent trials are required to establish whether rapid restoration of vitamin D body stores could impact the disease course and outcome of critical illness.


 

Last updated on 2 Jan 2013

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