title: Vitamin D Deficiency and Parathyroid Response in Critically-ill Children: Association with Illness Severity and Clinical Outcomes.
abstract: OBJECTIVE
  To determine the prevalence of vitamin D deficiency in critically ill children, and to study its association with parathyroid response, severity of illness and clinical outcomes.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical Pediatric Intensive Care Unit of a tertiary care centre of Northern India.
  
  
  METHODS
  154 children in-patients: August 2011-January 2013.
  
  
  METHODS
  Vitamin D deficient children were (serum 25-hydroxy vitamin D <20 ug/mL) divided into parathyroid-responder [serum parathyroid hormone >65 pg/mL with 25(OH)D<20 ug/mL and/or calcium corrected for albumin <8.5 mg/dL] and non parathyroid-responder. Illness severity was assessed by Pediatric Index of Mortality-2 (PIM-2) score at admission. Biochemical parameters, illness severity scores and clinical outcomes were compared between parathyroid-responders and non-parathyroid-responders.
  
  
  RESULTS
  Vitamin D deficiency and hypocalcemia were observed in 125 (83.1%) and 91 (59%) children, respectively at admission. There were no differences in illness severity score at admission, mortality rate and length of stay between vitamin D-deficient children and 19.8% of non-vitamin D-deficient children. Among Vitamin D-deficient children, parathyroid-responders had higher PIM-2 score at admission compared to non-parathyroid-responder [12.8 (7.4,20.6) vs. 6.5 (2.5,12.2), P=0.01]. However, there were no differences in other clinical outcomes between two groups.
  
  
  CONCLUSIONS
  Critically ill children have high prevalence of vitamin D deficiency. Parathyroid gland response secondary to hypocalcemia or vitamin D defiency is impaired in critical illness.
authors.affiliation: Departments of Pediatrics and *Endocrinology, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Rakesh Lodha, Additional Professor, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. rakesh_lodha@hotmail.com.
authors.forename: Satish Kumar
authors.initials: SK
authors.lastname: Shah
authors.forename: Sushil Kumar
authors.initials: SK
authors.lastname: Kabra
authors.forename: Nandita
authors.initials: N
authors.lastname: Gupta
authors.forename: Gautham
authors.initials: G
authors.lastname: Pai
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology*; D006801:Humans; D006996:Hypocalcemia / Q000150:complications* / Q000453:epidemiology*; D007194:India; D007223:Infant; D007231:Infant, Newborn; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology*
chemical_list: D010281:Parathyroid Hormone