Vitamin D Deficiency in Critically Ill Children

Madden, Kate; Feldman, Henry A.; Smith, Ellen M. Lavoie; Gordon, Catherine M.; Keisling, Shannon M.; Sullivan, Ryan M.; Hollis, Bruce W.; Agan, Anna A.; Randolph, Adrienne G.

doi:10.1542/peds.2011-3328

Cited by 129 publications

(171 citation statements)

References 43 publications

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“…In agreement with our results, Madden et al (20) , studied 511 critically ill children admitted to Boston Children's Hospital PICU. They found a high rate of vitamin D deficiency in their critically ill children as 40.1% of cases were vitamin D deficient.…”

Section: Discussionsupporting

confidence: 92%

“…(15) Though high prevalence of vitamin D deficiency in critically ill adults and children has been documented, the impact of such deficiency is not yet clear. Few studies have documented significant association of deficiency with poor outcomes such as longer duration of ICU stay (16,17) , increased inotropic requirement (18,19) and higher admission illness severity scores (16,20) All the parents or the legal guardians of the patients enrolled in this study signed a written informed consent before participation. The study was approved by the Medical Ethics Committee of the Faculty of Medicine, Alexandria University.…”

Section: Introductionmentioning

confidence: 99%

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Study of Serum Vitamin D Level among Critically Ill Patients Admitted to Alexandria University Pediatric Intensive Care Unit

Halwany¹

2017

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Study of Serum Vitamin D Level among Critically Ill Patients Admitted to Alexandria University Pediatric Intensive Care Unit

Halwany¹

2017

jmscr

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“…Additional studies of vitamin D deficiency in the pediatric intensive care unit (ICU) (PICU) population have reported a prevalence of between 30 and 86% (18)(19)(20)(21). We found lower 25(OH)D levels to be associated with greater illness severity (22); other pediatric critical care studies have confirmed this finding (19,21,23,24), although equal numbers have reported no correlation with illness severity or ICU outcomes (18-20, 25, 26). Despite the rapidly increasing volume of evidence linking 25(OH)D deficiency with ICU morbidity and mortality over the past 10 years (1-4, 6-8, 10, 11, 27, 28), the question of whether vitamin D repletion will improve clinical outcomes in critical illness remains unclear.…”

Section: Low Serum Concentrations Of Total 25-hydroxyvitamin D (25[oh]d)mentioning

confidence: 40%

“…These are the same risk factors we identified for low total 25(OH)D in the same population of children. Because lower circulating VDBP levels increase the proportion of 25(OH)D that is bioavailable, it follows that the total (22). We believe these results are an important consideration when interpreting total 25(OH)D levels in critically ill children, especially those at higher risk for low VDBP levels.…”

Section: Discussionmentioning

confidence: 93%

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Critically Ill Children Have Low Vitamin D Binding Protein, Influencing Bioavailability of Vitamin D

Madden¹,

Feldman²,

Chun³

et al. 2015

Annals ATS

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Rationale: Vitamin D deficiency, often defined by total serum 25-hydroxyvitamin D (25[OH]D) ,20 ng/ml, is common in critically ill patients, with associations with increased mortality and morbidity in the intensive care unit. Correction of vitamin D deficiency in critical illness has been recommended, and ongoing clinical trials are investigating the effect of repletion on patient outcome. The biologically active amount of 25(OH)D depends on the concentration and protein isoform of vitamin D-binding protein (VDBP), which is also an acutephase reactant affected by inflammation and injury.Objectives: We performed a secondary analysis of a cohort of critically ill children in which we reported a high rate of vitamin D deficiency, to examine how VDBP level and genotype would impact vitamin D status. Methods:We prospectively enrolled 511 children admitted to the pediatric intensive care unit over a 12-month period. Measurements and Main Results:We measured serum VDBP in 479 children. We genotyped single nucleotide polymorphisms rs7041 and rs4588 in the VDBP gene (GC) to determine haplotypes GC1F, GC1S, and GC2 in 178 subjects who consented, then calculated bioavailable 25(OH)D from serum 25(OH)D, VDBP, albumin, and GC haplotype. The median serum VDBP level was 159 mg/ml (interquartile range, 108-221), lower than has been reported in healthy children. Factors predicting lower levels in multivariate analysis included age ,1 year, nonwhite race, being previously healthy, 25(OH)D ,20 ng/ml and greater illness severity. In the subgroup that was genotyped, GC haplotype had the strongest association with VDBP level; carriage of one additional copy of GC1S was associated with a 37.5% higher level (95% confidence interval, 31.9-44.8; P , 0.001). Bioavailable 25(OH)D was also inversely associated with illness severity (r = 20.24, P , 0.001), and ratio to measured total 25(OH)D was variable and related to haplotype.Conclusions: Physiologic deficiency of 25(OH)D in critical illness may be more difficult to diagnose, given that lower VDBP levels increase bioavailability. Treatment studies conducted on the basis of total 25(OH)D level, without consideration of VDBP concentration and genotype, may increase the risk of falsely negative results.

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Intensive Care and Vitamin D Status

Youssef¹,

Amrein²,

Schnedl³

et al. 2015

Diet and Nutrition in Critical Care

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Vitamin D Deficiency in Critically Ill Children

Abstract: We found a high rate of vitamin D deficiency in critically ill children. Given the roles of vitamin D in bone development and immunity, we recommend screening of those critically ill children with risk factors for vitamin D deficiency and implementation of effective repletion strategies.

Cited by 129 publications

References 43 publications

Study of Serum Vitamin D Level among Critically Ill Patients Admitted to Alexandria University Pediatric Intensive Care Unit

Study of Serum Vitamin D Level among Critically Ill Patients Admitted to Alexandria University Pediatric Intensive Care Unit

Critically Ill Children Have Low Vitamin D Binding Protein, Influencing Bioavailability of Vitamin D

Intensive Care and Vitamin D Status

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