Can Serum 25-Hydroxy Vitamin D Levels Predict the Severity of Multisystem Inflammatory Syndrome in Children and COVID-19?

Abstract

Objective: To determine the clinical significance of serum 25-hydroxy (OH) vitamin D levels in pediatric patients with multisystem inflammatory syndrome in children (MIS-C) and compare the vitamin D levels of these patients with those patients with Coronavirus disease-2019 (COVID-19) and healthy controls. Methods: This study was designed for pediatric patients aged 1 month to 18 years and conducted between July 14 and December 25, 2021. Fifty-one patients with MIS-C, 57 who were hospitalized with COVID-19, and 60 controls were enrolled in the study. Vitamin D insufficiency was defined as a serum 25 (OH) vitamin D level of less than 20 ng/mL. Severe MIS-C was classified as necessitating intensive care due to cardiovascular instability, the necessity for non-invasive or invasive mechanical ventilation, and/or a diminishing Glasgow coma scale. World Health Organization definition criteria were used to describe the clinical stages of COVID-19 in children and patients were divided into four groups according to the clinical severity of COVID-19: asymptomatic, mild, moderate, and severe/critical. Results: The median serum 25 (OH) vitamin D was 14.6 ng/mL in patients with MIS-C, 16 ng/mL in patients with COVID-19, and 21.1 ng/mL in the control group (p<0.001). Vitamin D insufficiency was present in 74.5% (n=38) of patients with MIS-C, 66.7% (n=38) of patients with COVID-19, and 41.7% (n=25) of the controls (p=0.001). The percentage of four or more affected organ systems was 39.2% in patients with MIS-C. The correlation between the number of affected organ systems and serum 25 (OH) vitamin D levels was evaluated in patients with MIS-C and there was a moderate negative correlation (r=-0.310; p=0.027). A weak negative correlation was found between the severity of COVID-19 and serum 25 (OH) vitamin D (r=-0.320, p=0.015). Conclusion: Vitamin D levels were insufficient in both the MIS-C and COVID groups. Furthermore, vitamin D levels correlated with the number of affected organ systems in MIS-C and the severity of COVID-19.

The Impact of Vitamin D Levels on Clinical Manifestations of Multisystem Inflammatory Syndrome in Children: A Cross-Sectional Study

“…Additionally, they found VD insufficiency in 74% of their MIS-C patients, though they used a lower cutoff point for the diagnosis of VD insufficiency (50 nmol/L) than in our research. They also reported that MIS-C patients had significantly lower VD levels than participants in the control group [ 33 ]. A similar high incidence of hypovitaminosis D in pediatric MIS-C patients with a predominance of VD deficiency was found in other studies of different geographical origin [ 34 , 35 ].…”

“…They observed that the number of ≥4 affected organ systems was significantly higher in the group with inadequate 25(OH)D levels. Additionally, they pointed out that patients treated in the PICU had significantly lower 25(OH)D levels than patients in the non-PICU group, and that all of the patients with hypotension and signs of shock had inadequate 25(OH)D levels [ 33 ]. There is a connection between Kawasaki disease, a disease with very similar pathophysiology to MIS-C, and VD mentioned in the literature.…”

Decoding the paradox: Understanding Elevated Hospitalization and Reduced Mortality in SARS-CoV-2 Variants

“…In addition to its non-genomic anti-viral effects [107,108], the genomic actions of calcitriol enhance the transcription of several anti-microbial peptides, such as cathelicidin and defensin [109][110][111]. Vitamin D also stimulates immune cell chemotaxis [112,113] and reduces the severity of COVID-19 [114]. Nevertheless, individual response variations occur due to epigenetic variances [21,80].…”

Role of Vitamin D and Vitamin D Polymorphisms in COVID-19 Risk and Severity in Children: A Systematic Review

“…Several studies classified patients according to their serum 25(OH)D level of sufficiency, and variations were noted between the values defined as sufficient, insufficient, and deficient. Studies included in our systematic review determine vitamin D deficiency as levels of serum 25(OH)D less than 20 ng/mL (<50 nmol/L) [16][17][18], less than 12 ng/mL (<30 nmol/L) [9], or between 5 and 15 ng/mL [19], mild deficiency as of 21-30 ng/mL [20], and mild to moderate deficiency as of 10-24 ng/mL [21]. Two studies defined severe vitamin D deficiency as 25(OH)D levels below 10 ng/ml [21,22], and one study as less than 5 ng/mL [19].…”

“…Those with 25(OH)D levels of 21-29 ng/mL (52.5 and 72.5 nmol/l) [16,17] or 12-20 ng/mL (30-50 nmol/L) [9,23] were defined as vitamin D insufficient, and those with levels above 30 ng/ml (75 nmol/L) were considered to have normal levels [16,17]. COVID-19 disease was classified as asymptomatic, mild, moderate, severe, and critical according to clinical presentation.…”