Vitamin D Deficiency and Critical Illness

Prasad, Shailender; Raj, Dinesh; Warsi, Sumbul; Chowdhary, Sona

doi:10.1007/s12098-015-1778-3

Cited by 28 publications

(19 citation statements)

References 29 publications

(41 reference statements)

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“…Vitamin D deficiency is an important clinical condition that has been associated with many diseases and has been extensively researched over the last few years . The mechanism through which vitamin D deficiency has its effect in so many diseases is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…Vitamin D deficiency is an important clinical condition that has been associated with many diseases and has been extensively researched over the last few years. 2,3,5 The mechanism through which vitamin D deficiency has its effect in so many diseases is not fully understood. It is probable that one of these molecular mechanisms involves increased oxidative stress and impaired thiol/disulfide homeostasis, which are responsible for the pathophysiology of many diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Vitamin D deficiency is common in children and is associated with many diseases, such as diabetes, critical illness, and rickets . Although the mechanism by which vitamin D deficiency has its effect in most diseases is not fully understood, increased oxidative stress is known to play an important role.…”

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Vitamin D supplementation does not improve plasma thiol/disulfide homeostasis

Mertoğlu

Siranli

Topal

et al. 2018

Pediatrics International

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Background Impairment of thiol/disulfide homeostasis, as well as vitamin D deficiency, are responsible for the pathophysiology of many acute and chronic diseases. This study examined the relationship between thiol/disulfide homeostasis and vitamin D level and supplementation. Methods A total of 203 healthy children were included in the study. The participants were divided into four groups according to 25‐hydroxyvitamin D (25(OH)D) level: group 1, severe deficiency (<10 ng/mL); group 2, deficiency (10–20 ng/mL); group 3, insufficiency (20–30 ng/mL); and group 4, sufficiency (≥30 ng/mL). Furthermore, group 5 was defined as being on vitamin D supplementation. Result Native thiol was lower in group 5 than in groups 2–4 (P = 0.003). Disulfide was higher in groups 1, 4 and 5 than groups 2 and 3 (P < 0.001). Total thiol was lower in group 5 than in group 4 (P = 0.032). The ratio of native thiol/total thiol was lower in groups 1 and 5 compared with groups 2 and 3, and in group 4 compared with group 3 (P < 0.001). The ratios of disulfide/total thiol and disulfide/native thiol were higher in groups 1 and 5 than in groups 2 and 3 whereas only the disulfide/total thiol ratio was higher in group 4 than in group 3 (P < 0.001). Conclusions In healthy children, severe deficiency of vitamin D causes impairment of thiol/disulfide homeostasis and increases protein oxidation, which cannot be reversed by external vitamin D supplementation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vitamin D supplementation does not improve plasma thiol/disulfide homeostasis

Mertoğlu

Siranli

Topal

et al. 2018

Pediatrics International

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“…Therefore, it is impossible to determine whether the required VitD levels in different organs to maintain the best functional state differ or are identical [23]. Lee [24] proposed that VitD deficiency is essentially an imbalance between the supply and the demand from the tissues.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance and Prognostic Effect of Serum 25-hydroxyvitamin D Concentrations in Critical and Severe Hand, Foot and Mouth Disease

Dang

Liu

et al. 2017

Nutrients

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Objective: To examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with critical and severe hand, foot and mouth disease (HFMD) and assess the clinical significance and prognostic effect of 25(OH)D concentrations in children with HFMD. Methods: This is a prospective observational study. The 138 children with HFMD were divided into common (49 cases), severe (52 cases), and critical (37 cases) HFMD groups. Another 59 healthy children undergoing outpatient medical examinations during the same period were chosen as the control group. Serum 25(OH)D concentrations were measured in all the subjects, and each group was subdivided by serum 25(OH)D concentration into 25(OH)D normal (≥30 ng/mL); insufficiency (20–29.9 ng/mL), and deficiency (<20 ng/mL) groups. The pediatric critical illness score (PCIS) was recorded for the critical and severe HFMD group upon admission to the pediatric intensive care unit (PICU). Children with critical and severe HFMD were also monitored for blood lactate (LAC), serum calcium ions (Ca++), D-dimer (DD), lactate dehydrogenase (LDH), and creatine kinase-MB (CK-MB) levels; the incidences of brainstem encephalitis, neurogenic pulmonary edema, and circulatory failure; and the 14-day mortality rate. Results: Serum 25(OH)D concentrations were generally low in all groups. The critical HFMD group showed a significantly lower serum 25(OH)D mean concentration (20.0 ± 8.4 ng/mL) and a higher proportion of deficiency (18%) compared with the control group (28.1 ± 6.6 ng/mL, 8%), common (29.5 ± 8.1 ng/mL, 10%) and severe (31.9 ± 9.7 ng/mL, 8%) HFMD groups (p < 0.05). In the critical and severe HFMD groups, the 25(OH)D deficiency group had lower PCISs than the 25(OH)D normal and insufficiency groups (p < 0.05); and had higher values than the latter two groups for LAC, LDH, CK-MB and DD; and the incidences of brainstem encephalitis, neurogenic pulmonary edema, circulatory failure, and mortality (p < 0.05). The death group showed significantly lower serum 25(OH)D concentrations and PCISs than the survival group (p < 0.05) and had higher LAC, LDH, CK-MB and DD levels and higher incidences of brainstem encephalitis, neurogenic pulmonary edema, and circulatory failure (p < 0.05). Logistic regression analysis revealed that the serum 25(OH)D concentration was an independent factor that influenced mortality in children with critical and severe HFMD. Conclusions: In this study, we find the serum 25(OH)D concentrations are substantially reduced in children with critical and severe HFMD and are associated with the severity of HFMD. The serum 25(OH)D concentrations may have clinical value for determining the progression of critical HFMD and predicting the risk of death. Further evidence is needed before it can be stated that 25(OH)D concentrations have clinical value in HMFD diagnosis.

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Vitamin D Deficiency and Critical Illness: Author’s Reply

Raj

2016

Indian J Pediatr

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We thank the readers for going through our study which highlighted the potential role of vitamin D in critical illness [1]. Vitamin D possibly affects antimicrobial response by its action on the cells of the immune system. Apart from this vitamin D also has effects on the cardiovascular and metabolic pathways, which are of immense importance in a critically ill child. Critical illnesses leading to PICU admission are diverse. The heterogeneity in the diseases in our study makes it impossible to highlight the differences in vitamin D among these children with various underlying causes. Moreover, our study was not powered enough to identify these differences. However, we still performed a subgroup analysis to identify any difference in vitamin D levels in children presenting with various underlying causes. No difference in vitamin D levels was found. Probably larger and more specific studies are needed to evaluate the role of vitamin D in different diseases leading to PICU admission.Our study found that malnourished children had higher vitamin D levels compared to normally nourished children, but the difference was not statistically significant. Data are limited on the association of nutritional status and vitamin D deficiency. No previous study has compared vitamin D levels in malnourished and well nourished critically ill children. A recent small case control study from Uganda which enrolled healthy children and malnourished children from acute care ward, inpatient ward, and outpatient department found no difference in vitamin D levels between malnourished and well nourished children [2].There are no guidelines on the routine evaluation of vitamin D levels in sick children. Randomized controlled trials are needed to assess whether vitamin D supplementation improves outcomes in these sick children. Till that time, routine vitamin D supplementation of exclusively breast babies and targeted assessment in sick children should suffice.

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Vitamin D Deficiency and Critical Illness

Abstract: Vitamin D appears to be of utmost importance in critically ill children.

Cited by 28 publications

References 29 publications

Vitamin D supplementation does not improve plasma thiol/disulfide homeostasis

Vitamin D supplementation does not improve plasma thiol/disulfide homeostasis

Clinical Significance and Prognostic Effect of Serum 25-hydroxyvitamin D Concentrations in Critical and Severe Hand, Foot and Mouth Disease

Vitamin D Deficiency and Critical Illness: Author’s Reply

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