Vitamin D deficiency relation to sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and duration of mechanical ventilation in critically ill children: A meta‐analysis

Abstract

Introduction Vitamin D deficiency in children is related to the augmented risk of bone illnesses, but its effect on critically ill children is still conflicting. This meta‐analysis study was performed to assess the relationship between vitamin D deficiency in children and sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and duration of mechanical ventilation in critically ill children. Methods Through a systematic literature search up to June 2020, 16 studies with 2382 children, 1229 children of them with vitamin D deficiency, were found recording relationships between vitamin D deficiency and sepsis, paediatric risk of mortality III score, need for ventilation support, length of hospital stay, and/or duration of mechanical ventilation. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated between vitamin D deficiency children to non‐vitamin D deficiency children on the different outcomes in critically ill children using the dichotomous or continuous methods with a random or fixed‐effect model. Results The vitamin D deficiency children category had significantly higher sepsis (OR, 2.35; 95% CI, 1.19‐4.63, P = .01); paediatric risk of mortality III score (OR, 2.19; 95% CI, 1.13‐4.25, P = .02); higher length of hospital stay (OR, 4.26; 95% CI, 0.81‐7.70, P = .02); higher duration of mechanical ventilation (OR, 1.89; 95% CI, 0.22‐3.56, P = .03) compared with that in the non‐vitamin D deficiency children. However, the need for ventilation support in vitamin D deficiency children did not significantly differ from non‐vitamin D deficiency children (OR, 2.00; 95% CI, 0.98‐4.07, P = .06) with relatively higher results in vitamin D deficiency children. Conclusions Vitamin D deficiency in children might have an independent relationship with higher sepsis, paediatric risk of mortality III score, length of hospital stay, and duration of mechanical ventilation. The relation was relative with a higher risk in need for ventilation support with vitamin D deficiency children. This relationship encouraged us to recommend testing vitamin D levels in all critically ill children and providing them with supplemental vitamin D as prophylaxis.

An Observational Study of Serum Vitamin D Status in Critically Ill Children Admitted to the Pediatric Intensive Care Unit

“…Children with vitamin D deficiency were found to have a higher risk of sepsis than children without vitamin D deficiency in a recent meta-analysis involving 2382 children [10]. In the study…”

“…Vitamin D acts in the regulation of innate immune cells and defense against infectious agents through the activation of toll-like receptors in the host cell and the production of cathelicidin, an antimicrobial peptide [1,3,4]. Meta-analyses evaluating vitamin D levels in critically ill adults and children have suggested an association between vitamin D deficiency and a potential increased risk of developing severe infections including coronavirus disease 2019 [9][10][11].…”

“…Hypovitaminosis D has also been hypothesized to be a possible risk factor for morbidity and mortality in critical illness admission [2,4]. Studies worldwide in acutely ill adult and pediatric patients have revealed a high prevalence of hypovitaminosis D associated with poor outcomes [2,[9][10][11][12]. A prevalence of hypovitaminosis D ranging from 30% to 70% has been reported in pediatric intensive care unit (PICU) patients, and hypovitaminosis D at PICU admission has been associated with increased illness severity and mortality, and longer hospital stays [2,10,[12][13][14].…”

Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections?

“…However, a possible association between severe vitamin D deficiency and respiratory tract infections was historically hypothesized due to the identification of a significant increased risk of pneumonia and respiratory complications in rachitic children, a condition known as rachitic lung [ 124 , 125 , 126 ]. A significant association between 25-hydroxyvitamin D [25(OH)D] levels and other pediatric infections has also been found, including urinary tract infections [ 127 ], otitis media [ 128 ], acute diarrhea [ 129 ], rotavirus infection [ 130 ], malaria [ 131 ], leishmaniosis [ 132 ], hepatitis C [ 133 ], and sepsis [ 134 , 135 , 136 ]. Moreover, some studies investigated a possible relationship between vitamin D deficiency and tuberculosis infection in children, with discordant results [ 137 , 138 ].…”

“…In Table 4 we reported the meta-analyses that evaluated the association between vitamin D status or vitamin D supplementation with infections risk or severity in children [ 127 , 128 , 134 , 135 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 ]. Most of meta-analyses confirmed a significant protective role of vitamin D supplementation against respiratory infections; particularly, major benefits were observed in children and adolescents, asthmatic subjects, individuals with severe vitamin D deficiency, and those receiving a daily dosing regimen (400–1000 IU/day) for a duration of 12 months or less.…”