Association between vitamin D status and sepsis in children: A meta-analysis of observational studies

Xiao, Dongqiong; Zhang, Xiaoyan; Ying, Junjie; Zhou, Yan; Li, Xihong; Mu, Dezhi; Qu, Yi

doi:10.1016/j.clnu.2019.08.010

Cited by 22 publications

(19 citation statements)

References 26 publications

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“… 19 It has been reported that the 25(OH)D levels in South Indian subjects are relatively higher compared with the subjects from North India, and there is a strong inverse correlation between the 25(OH)D levels and latitude. 20 Hence, the lower prevalence of vitamin D deficiency in children with sepsis in the present study compared to other studies could be due to dietary differences, geographical differences of altitude and latitude, 6 , 20 in addition to the differences in the underlying disease conditions, methods of estimation of vitamin D, 4 the criteria for PICU admissions, and study settings.…”

Section: Discussionmentioning

confidence: 54%

“… 12 , 17 Hence, our study concurs with the large body of evidence supporting a significant association between vitamin D deficiency or lower 25(OH)D level and sepsis in children. 4 …”

Section: Discussionmentioning

confidence: 99%

“… 3 Studies have reported that children with sepsis have lower vitamin D levels than control participants. 4 It is also known that sepsis is a major cause of pediatric deaths the world over. Mortality ranged from 1 to 5% for sepsis and 9 to 20% for severe sepsis among children globally.…”

Section: Introductionmentioning

confidence: 99%

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Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study

Kubsad¹,

Ravikiran²,

Bhat³

et al. 2021

Indian Journal of Critical Care Medicine

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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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Section: Discussionmentioning

confidence: 54%

“… 12 , 17 Hence, our study concurs with the large body of evidence supporting a significant association between vitamin D deficiency or lower 25(OH)D level and sepsis in children. 4 …”

Section: Discussionmentioning

confidence: 99%

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Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study

Kubsad¹,

Ravikiran²,

Bhat³

et al. 2021

Indian Journal of Critical Care Medicine

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“…Vitamin D3 is mainly produced in the skin after exposure to ultraviolet rays from sunlight ( Teymoori-Rad et al, 2019 ). The active form of vitamin D, 1,25(OH)D (1,25 dihydroxy vitamin D), binds to the vitamin D receptor (VDR) to play anti-inflammatory and immune regulatory roles ( Gou et al, 2018 , Xiao et al, 2019 ). VDR interacts with 1,25(OH)D and then binds to vitamin D responsive elements (VDREs) to inhibit or promote the expression of target genes, such as enhancement of ACE2 expression ( Cui et al, 2019 ).…”

Section: Could Sars-cov-2-induced Lung Injury Be Attenuated By Vitamimentioning

confidence: 99%

Could SARS-CoV-2-induced lung injury be attenuated by vitamin D?

Xiao

Su³

et al. 2021

International Journal of Infectious Diseases

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Highlights As a counter-regulatory arm of the renin-angiotensin system (RAS), ACE2 plays critical roles in the pathogenesis of ARDS and acute lung injury. The affinity of the spike protein receptor binding domain (RBD) of the SARS-CoV-2 with human ACE2 (hACE2) largely determines the degree of clinical symptoms infected by SARS-CoV-2. Vitamin D was found to affect ACE2, the same target of SARS-CoV-2, we therefore propose that vitamin D might alleviate ARDS and acute lung injury induced by SARS-CoV-2 through modulating ACE2.

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“…Observational clinical studies have demonstrated that vitamin D deficiency is common in critically ill children, with a prevalence ranging from 35 to 85%. 82 – 85 While levels are lower in adult non-survivors compared to survivors, 77 , 86 , 87 observational outcome studies in children are conflicting, with some describing increased severity of illness with vitamin D deficiency, 84 while others showing no difference in the severity of illness or mortality. 82 , 83 , 88 Reviews and meta-analyses in children also demonstrate conflicting results.…”

Section: Vitamin Dmentioning

confidence: 99%

Vitamin therapy in sepsis

et al. 2021

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Vitamins are essential micronutrients with key roles in many biological pathways relevant to sepsis. Some of these relevant biological mechanisms include antioxidant and anti-inflammatory effects, protein and hormone synthesis, energy generation, and regulation of gene transcription. Moreover, relative vitamin deficiencies in plasma are common during sepsis and vitamin therapy has been associated with improved outcomes in some adult and pediatric studies. High-dose intravenous vitamin C has been the vitamin therapy most extensively studied in adult patients with sepsis and septic shock. This includes three randomized control trials (RCTs) as monotherapy with a total of 219 patients showing significant reduction in organ dysfunction and lower mortality when compared to placebo, and five RCTs as a combination therapy with thiamine and hydrocortisone with a total of 1134 patients showing no difference in clinical outcomes. Likewise, the evidence for the role of other vitamins in sepsis remains mixed. In this narrative review, we present the preclinical, clinical, and safety evidence of the most studied vitamins in sepsis, including vitamin C, thiamine (i.e., vitamin B 1 ), and vitamin D. We also present the relevant evidence of the other vitamins that have been studied in sepsis and critical illness in both children and adults, including vitamins A, B 2 , B 6 , B 12 , and E. Impact Vitamins are key effectors in many biological processes relevant to sepsis. We present the preclinical, clinical, and safety evidence of the most studied vitamins in pediatric sepsis. Designing response-adaptive platform trials may help fill in knowledge gaps regarding vitamin use for critical illness and association with clinical outcomes.

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Association between vitamin D status and sepsis in children: A meta-analysis of observational studies

Cited by 22 publications

References 26 publications

Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study

Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study

Could SARS-CoV-2-induced lung injury be attenuated by vitamin D?

Vitamin therapy in sepsis

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