Vitamin D Deficiency and Parathyroid Response in Critically-ill Children: Association with Illness Severity and Clinical Outcomes.
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Date
2016-06
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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.
Design: Prospective observational study.
Setting: Medical Pediatric Intensive Care Unit of a tertiary care centre of Northern India.
Participants: 154 children in-patients: August 2011-January 2013.
Main outcome measures: Vitamin D deficient children were (serum 25-hydroxy vitamin D <20 µg/mL) divided into "parathyroid-responder" [serum parathyroid hormone >65 pg/mL with 25(OH)D<20 µg/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.
Conclusion: 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.
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Keywords
Calcium, Illness severity, Outcome
Citation
Satish Kumar Shah, Sushil Kumar Kabra,Nandita Gupta, Gautham Pai and Rakesh Lodha. Vitamin D Deficiency and Parathyroid Response in Critically-ill Children: Association with Illness Severity and Clinical Outcomes. Indian Pediatrics. 2016 Jun; 53(6): 479-484.