Déficit de vitamina D y morbimortalidad en pacientes críticos pediátricos

García-Soler, Patricia; Morales-Martínez, Antonio; Rosa-Camacho, Vanessa; Lillo-Muñoz, Juan Antonio; Milano-Manso, Guillermo

doi:10.1016/j.anpedi.2016.09.005

Cited by 6 publications

(6 citation statements)

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“…With the exception of Gauthier et al [ 54 ], researchers in all studies investigated the relationship between vitamin D status and at least one risk factor (Additional file 6 ). Factors identified as significantly associated with lower vitamin D levels in more than one study included weight ( n = 4) [ 55 , 62 , 65 , 70 ] (i.e., body mass index [BMI]), lower nutritional status ( n = 6) [ 55 , 62 , 65 – 67 , 70 ] (i.e., failure to thrive), older age ( n = 6) [ 55 , 56 , 60 , 65 , 70 , 72 ], admission type ( n = 4) [ 62 , 65 , 69 , 70 ] (i.e., nontrauma, cardiac, metabolic/renal), seasons with decreased ultraviolet light exposure ( n = 5) [ 57 , 60 , 70 – 72 ], non-Caucasian race ( n = 4) [ 55 , 57 , 60 , 70 ], and absence of supplementation ( n = 2) [ 60 , 63 ].…”

Section: Resultsmentioning

confidence: 99%

Vitamin D deficiency in critically ill children: a systematic review and meta-analysis

et al. 2017

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BackgroundVitamin D deficiency (VDD) has been hypothesized not only to be common but also to represent a potentially modifiable risk factor for greater illness severity and clinical outcome during critical illness. The objective of this systematic review was to determine the frequency of VDD in pediatric critical illness and its association with clinical outcomes.MethodsMEDLINE, Embase, and CENTRAL were searched through December 12, 2016, with no date or language restrictions. The primary objective was to estimate the prevalence of VDD in the pediatric intensive care unit (PICU) and compare vitamin D status with healthy control populations. Secondary objectives were to evaluate whether VDD is associated with mortality, increased illness severity, PICU interventions, and patient clinical course. Random effects meta-analysis was used to calculate pooled VDD event rate, compare levels with those of control subjects, and evaluate for associations between VDD and clinical outcome.ResultsAmong 2700 citations, 17 studies meeting study eligibility were identified. The studies reported a total of 2783 critically ill children and had a median sample size of 120 (range 12–511). The majority of studies used a 25-hydroxyvitamin D [25(OH)D] level less than 50 nmol/L to define VDD, and the pooled VDD prevalence was 54.8 (95% CI 45.4–63.9). Average 25(OH)D levels were significantly lower in PICU patients than in healthy control subjects (pooled difference −17.3 nmol/L, 95% CI −14.0 to −20.6). In a meta-analysis calculation, we found that VDD was associated with increased mortality (OR 1.62, 95% CI 1.11–2.36), illness severity, and need for PICU interventions.ConclusionsApproximately 50% of critically ill children have VDD at the time of PICU admission, defined as a blood total 25(OH)D concentration under 50 nmol/L. VDD was further determined to be associated with greater illness severity, multiple organ dysfunction, and mortality in the PICU setting. Clinical trials are required to determine if optimization of vitamin D status improves patient outcome.Trial registrationPROSPERO, CRD42016026617. Registered on 11 January 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1875-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Vitamin D deficiency in critically ill children: a systematic review and meta-analysis

et al. 2017

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“…However, with respect to weight, our results are in concordance with the results obtained by Rey et al (p < 0.001) and García-Soler et al (p ¼ 0.041). 10,23 In the present study, out of 93 patients reported during winter, 66.7% were vitamin D deficient whereas out of 32 patients reported in summer season, 87.5% were vitamin D deficient. As per our study, more of vitamin D deficient patients were admitted in winter but risk of VDD was higher in summer (r s ¼ 0.211, p ¼ 0.018) and risk of VDD was 3.9 times higher in summer season which is in contrast to study by Garcia where risk of VDD was higher in winters (OR ¼ 2.93, p ¼ 0.04).…”

Section: Discussionmentioning

confidence: 42%

“…As per our study, more of vitamin D deficient patients were admitted in winter but risk of VDD was higher in summer (r s ¼ 0.211, p ¼ 0.018) and risk of VDD was 3.9 times higher in summer season which is in contrast to study by Garcia where risk of VDD was higher in winters (OR ¼ 2.93, p ¼ 0.04). 23 However, McNally et al did not find a significant correlation of percentage of vitamin-deficient patients with season (p ¼ 0.09). 12 Risk of mechanical ventilation (►Table 2) was correlated to VDD (r This document was downloaded for personal use only.…”

Section: Discussionmentioning

confidence: 93%

“…22 However, in another study conducted by García-Soler et al, 36 and 29% of the patients had hemodynamic and neurological involvement. 23 In previous studies it was reported that the risk of VDD increases with the increasing age. 24 Our study supports this finding as statistically significant correlation was observed between VDD and increasing age (►Table 1) (symbol of chi square 51.46, p-value ¼ 0.05) and this was further proved by multivariate analysis where VDD increased proportionally to increasing age.…”

Section: Notementioning

confidence: 97%

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Correlation of Vitamin D Deficiency with Predictors of Mortality in Critically Ill Children at a Tertiary Care Centre in North India—A Prospective, Observational Study

Bansal

Kaur

Rai

et al. 2020

J Pediatr Intensive Care

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This study was conducted to assess the relationship of vitamin D deficiency (VDD) with various demographic characteristics, laboratory parameters, and predictors of mortality. This prospective observational study was performed at pediatric intensive care unit (PICU) of a tertiary care hospital situated in north India. A total of 125 children admitted in PICU with age from 2 months to 14 years were analyzed. The subjects were classified as Vitamin D deficient (≤20 ng/mL) and nondeficient (>20 ng/mL). The relationship between VDD and predictors of mortality were analyzed using correlation and multivariate analysis. Respiratory system (40%) was most commonly involved. VDD was seen in 72% of the patients. There was statistically significant correlation of VDD with age (p = 0.019), season (p = 0.018), height (p = 0.005), and weight (p = 0.003). On multivariate analysis factors associated with VDD were age (odds ratio [OR] = 1.01, 95% confidence interval [CI] 1.00–1.03, p = 0.006), season (OR = 3.98, 95% CI 1.09–14.50, p = 0.036). VDD was also correlated to bacteriuria (p = 0.033), cardiovascular sequential sepsis-related organ failure assessment score (CV-SOFA score) (p = 0.001), and mechanical ventilation (p = 0.043). On multivariate analysis, factors associated with VDD were bacteriuria (OR = 4.88, 95% CI 1.04–22.89, p = 0.04), mechanical ventilation requirement (OR = 2.95, 95% CI 1.12–7.85, p = 0.029), and CV-SOFA score (OR = 2.33, 95% CI 1.14–4.76, p = 0.021). Median (interquartile range) duration of PICU stay in VDD patients was (3–7) days while in nondeficient patients it was (2–6) days (p = 0.107). VDD was a significant risk factor for the need of mechanical ventilation, bacteriuria, and mortality among patients in our cohort.

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“…Recently, various studies demonstrated that the prevalence of vitamin D deficiency (VDD) among critically ill children at admission to pediatric intensive care unit was in the range of 25% to 84%. 1 –8 Adding to the available literature, the research article by Sankar et al 9 entitled “Effect of severe vitamin D deficiency at admission on shock reversal in children with septic shock: A prospective observational study” is an interesting read. Authors noted that in 43 children with septic shock, the prevalence of severe VDD (serum 25[OH]D < 10 ng/mL) was 72% and 69% at admission and 72 hours, respectively.…”

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confidence: 99%

Severe Vitamin D Deficiency at Admission and Shock Reversal in Children With Septic Shock

Angurana

Guglani

2017

J Intensive Care Med

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Déficit de vitamina D y morbimortalidad en pacientes críticos pediátricos

Cited by 6 publications

References 126 publications

Vitamin D deficiency in critically ill children: a systematic review and meta-analysis

Vitamin D deficiency in critically ill children: a systematic review and meta-analysis

Correlation of Vitamin D Deficiency with Predictors of Mortality in Critically Ill Children at a Tertiary Care Centre in North India—A Prospective, Observational Study

Severe Vitamin D Deficiency at Admission and Shock Reversal in Children With Septic Shock

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