title: Serum Vitamin D Status and Outcome among Critically Ill Children Admitted to the Pediatric Intensive Care Unit in South India.
abstract: OBJECTIVE
  To determine the vitamin D status and the association between vitamin D status and the clinical outcome of critically ill children admitted to pediatric intensive care unit (PICU) in South India.
  
  
  METHODS
  Fifty-four consecutive children with medical and surgical diagnoses were included with parental consent. Severity of illness was assessed using PIM-2 score; Sequential Organ Failure Assessment Cardiovascular Score (CV-SOFA) was used to describe vasopressor use. Serum for 25(OH) D levels was obtained as close as possible to the ICU admission. Vitamin D deficiency was defined as serum 25(OH) D level < 20 ng/ml (50 nmol/L). Primary outcome measures were serum 25(OH) D level and in-hospital all cause mortality. Secondary outcomes were illness severity, vasopressor requirement, use of mechanical ventilation and duration of ICU stay.
  
  
  RESULTS
  Of the 54 children, two were excluded due to insufficient serum for vitamin D analysis. Median age was 17.5 mo (IQR = 4.5-78); 38.5 % were infants. Higher age was associated with low vitamin D levels (r s  = -0.34; p 0.01). Median serum 25(OH) D level was 25.1 ng/ml (IQR = 16.2-34.2). Shock (30.8 %), CNS conditions (23.1 %) and respiratory illnesses (21.2 %) were the three most common reasons for admission to the PICU. Vitamin D deficiency was seen in 40.3 % of the critically ill children. Higher PIM score or SOFA score were associated with low vitamin levels (r s  = -0.29, p 0.04 and r s  = -0.29, p 0.05 respectively). Children who were mechanically ventilated had a significantly lower median serum 25(OH) D level than those who were not on ventilation [19.5 ng/ml (IQR = 14.6-27.7)] vs. 32.1 ng/ml[(IQR = 16.5-50.9), p 0.01]. Serum 25(OH) D level was also positively associated with serum calcium levels (r s = 0.32, p 0.03). The proportion of children who died or were discharged terminally at parental request was 23.8 % among those with serum 25(OH) D level < 20 ng/ml as compared to 16.1 % among those with serum 25(OH) D level > 20 ng/ml (p 0.49).
  
  
  CONCLUSIONS
  Vitamin D deficiency is common among pediatric patients admitted to PICU in South India. Low serum 25(OH) D level was associated with higher severity of illness, need for mechanical ventilation, more vasopressor use and lower serum calcium levels. No association between vitamin D status and mortality was demonstrated.
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, 632004, Tamil Nadu, India. kinbaraj@cmcvellore.ac.in.
authors.forename: Kala
authors.initials: K
authors.lastname: Ebenezer
authors.affiliation: Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Victoria
authors.initials: V
authors.lastname: Job
authors.affiliation: Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Belavendra
authors.initials: B
authors.lastname: Antonisamy
authors.affiliation: Global Health Centre, Cincinnati Children's Medical Centre, Cincinnati, OH, USA.
authors.forename: Adekunle
authors.initials: A
authors.lastname: Dawodu
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
authors.forename: M N
authors.initials: MN
authors.lastname: Manivachagan
authors.affiliation: Global Health Centre, Cincinnati Children's Medical Centre, Cincinnati, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Steinhoff
mesh_terms: D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D013223:Statistics as Topic; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D014807:Vitamin D
keywords: Critically ill children; Vitamin D