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Indian Pediatr 2017;54: 160-161 |
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Is Vitamin D Deficiency Linked to Critical
Illness?
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Suresh Kumar Angurana and *Savita Verma Attri
Department of Pediatrics, Advanced Pediatrics Centre,
PGIMER, Chandigarh, India.
Email: [email protected]
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In recent years, dozen of studies have demonstrated that the prevalence
of vitamin D deficiency (VDD) among critically-ill children at admission
to pediatric intensive care unit (PICU) was in range of 25%-84% [1-5].
Few of these demonstrated that VDD was associated with greater severity
of illness and longer PICU stay [1-3].
We read with interest the research article on the
topic by Shah, et al. [5]. Authors demonstrated a high prevalence
of VDD (83.1%) among 154 critically-ill children. They noted no
differences in severity of illness at admission, mortality, and duration
of PICU stay among vitamin D-deficient and non-deficient children. The
high prevalence of VDD in this study cohort could be due to high
prevalence of malnutrition (65.6%) and presence of chronic illness
(55.4%), which directly or indirectly could have influenced vitamin D
status. It could have been better if authors had included matched
controls to account for the baseline prevalence of VDD in the given
population.
Recently, we demonstrated that the prevalence of VDD
(level <20 ng/mL) among 124 critically-ill children with sepsis and 338
healthy controls was 50.8% and 40.2%, respectively (P=0.04) [4].
We also noted that the severity of illness assessed by PRISM III and
SOFA scores was not significantly different between cases with VDD and
those with non-deficient levels of vitamin D, though the PRISM III score
was slightly higher in cases with VDD. Also, there was a trend toward
increased occurrence of septic shock and MODS, requirement for
catecholamines and mechanical ventilation, development of healthcare
associated infections, and occurrence of hypocalcemia in cases with VDD;
though the difference was not statistically significant. Whereas Shah,
et al. [5] noted lower mortality, shorter PICU stay, lesser
requirement and duration of mechanical ventilation, and lesser incidence
of ARDS in vitamin D-deficient cases. This was in contrast to previous
studies [1-4]. Shah, et al. [5] mistakenly mentioned non-vitamin
D deficient children as 19.8% in abstract section, which should be
16.9%.
Larger multicentric studies are needed to determine
the prevalence of VDD, association of VDD with clinically important
outcomes, and effect of supplementation of vitamin D in critically-ill
children. Till then, it is important for critical care physicians to
carefully examine the results of available studies before clinical
applicability.
Acknowledgement: Dr Renu Suthar for providing
intellectual inputs and critically reviewing manuscript.
References
1. Madden K, Feldman HA, Smith EM, Gordon CM,
Keisling SM, Sullivan RM, et al. Vitamin D deficiency in
critically ill children. Pediatrcs. 2012;130:421-8.
2. McNally JD, Menon K, Chakraborty P, Fisher L,
Williams KA, Al-Dirbashi OY, et al. The association of vitamin D
status with pediatric critical illness. Pediatrics. 2012;130: 429-36.
3. Ebenezer K, Job V, Antonisamy B, Dawodu A,
Manivachagan MN, Steinhoff M. Serum vitamin D status and outcome among
critically ill children admitted to the pediatric intensive care unit in
south India. Indian J Pediatr. 2015;83:120-5.
4. Ponnarmeni S, Kumar Angurana S, Singhi S, Bansal
A, Dayal D, Kaur R, et al. Vitamin D deficiency in critically ill
children with sepsis. Paediatr Int Child Health. 2016;36:15-21.
5. Shah SK, Kabra SK, Gupta N, Pai G, Lodha R. Vitamin D deficiency
and parathyroid response in critically-ill children: association with
illness severity and clinical outcomes. Indian Pediatr. 2016;53:479-84.
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