Vitamin D status of children with paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS)

Darren, Angeline; Osman, Mugtaba; Masilamani, Kavitha; Ali, Syed Habib; Kanthimathinathan, Hari Krishnan; Chikermane, Ashish; Al‐Abadi, Eslam; Welch, S; Hackett, Scott; Scholefield, Barnaby R; Uday, Suma; Jyothish, Deepthi

doi:10.1017/s0007114521001562

Cited by 15 publications

(21 citation statements)

References 30 publications

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“…For example, in the study by Darren et al, vitamin D levels were found to be < 20 ng/mL in all of the pediatric patients with MIS-C followed up in the ICU. 20 We think that a vitamin D level of < 20 ng/mL is an important risk factor for increased inflammation and may be important for cytokine storm, which is seen in MIS-C disease. Thus, vitamin D may affect inflammatory cytokines and contribute to the clinical status and excessive inflammatory response during the MIS-C disease.…”

Section: Discussionmentioning

confidence: 98%

“…2 Although there are studies evaluating the association of vitamin D deficiency with SARS-CoV-2 mortality, inflammation, and severity in adults and children, 6,7,19 the number of articles evaluating the association between MIS-C and vitamin D is limited. 20,21 In this study, 25-OHD levels of patients with MIS-C were evaluated. We found that there was a significant relationship between vitamin D levels (< 20 ng/mL) and the inflammatory parameters in our patients.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children

Kan

Türe

Akın

et al. 2022

J Pediatr Infect Dis

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Objective Multiple factors being overweight, asthmatic, or being of Asian or black ethnic origins have been reported vis-à-vis the “multisystem inflammatory syndrome in children” (MIS-C). There is an association between these conditions and vitamin D deficiency, which explains why MIS-C is more common in these patients. In the present study, we attempted to retrospective evaluate the 25-hydroxy vitamin D levels of patients with MIS-C, its association with acute phase reactants, its treatment, and clinical status. Methods Patients aged between 1.5 months to 18 years with MIS-C were included in the study. All of the laboratory parameters, treatment, and response to the treatment were evaluated retrospectively. Two groups were formed. Patients had 25‐hydroxycholecalciferol D vitamin < 20 ng/mL in group 1 and ≥ 20 ng/mL in group 2. Results A total of 52 patients were included in the study. There was no statistical difference between groups in terms of acceptance of the intensive care unit treatment (p = 0.29) and response to the first-line treatment (p = 0.56). A lower median lymphocyte count (p = 0.01) and a higher median C-reactive protein (p = 0.04) and procalcitonin (p = 0.01) with N-terminal pro-B-type natriuretic peptide (p = 0.025) values were found in group 1. Conclusion Vitamin D deficiency was associated with an increased inflammatory response in children with MIS-C. More studies are required to determine the potential impact of vitamin D deficiency on the clinical outcome of MIS-C.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children

Kan

Türe

Akın

et al. 2022

J Pediatr Infect Dis

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“…Beyazgül et al 30 reported that school-aged children and adolescents had low 25 (OH) D levels during COVID-19 pandemic period due to the restriction rules applied to prevent COVID-19 spreads. Darren et al 31 was the first to study vitamin D status in pediatric multi-system inflammatory syndrome associated with SARS-CoV-2 (PIMS-TS). They reported that 72% of their cohort was vitamin D deficient and specifically all PICU patients had suboptimal vitamin D level.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D deficiency and vitamin D receptor FokI polymorphism as risk factors for COVID-19

et al. 2022

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Background Given the sparse data on vitamin D status in pediatric COVID-19, we investigated whether vitamin D deficiency could be a risk factor for susceptibility to COVID-19 in Egyptian children and adolescents. We also investigated whether vitamin D receptor (VDR) FokI polymorphism could be a genetic marker for COVID-19 susceptibility. Methods One hundred and eighty patients diagnosed to have COVID‐19 and 200 matched control children and adolescents were recruited. Patients were laboratory confirmed as SARS-CoV-2 positive by real-time RT-PCR. All participants were genotyped for VDR Fok1 polymorphism by RT-PCR. Vitamin D status was defined as sufficient for serum 25(OH) D at least 30 ng/mL, insufficient at 21–29 ng/mL, deficient at <20 ng/mL. Results Ninety-four patients (52%) had low vitamin D levels with 74 (41%) being deficient and 20 (11%) had vitamin D insufficiency. Vitamin D deficiency was associated with 2.6-fold increased risk for COVID-19 (OR = 2.6; [95% CI 1.96–4.9]; P = 0.002. The FokI FF genotype was significantly more represented in patients compared to control group (OR = 4.05; [95% CI: 1.95–8.55]; P < 0.001). Conclusions Vitamin D deficiency and VDR Fok I polymorphism may constitute independent risk factors for susceptibility to COVID-19 in Egyptian children and adolescents. Impact Vitamin D deficiency could be a modifiable risk factor for COVID-19 in children and adolescents because of its immune-modulatory action. To our knowledge, ours is the first such study to investigate the VDR Fok I polymorphism in Caucasian children and adolescents with COVID-19. Vitamin D deficiency and the VDR Fok I polymorphism may constitute independent risk factors for susceptibility to COVID-19 in Egyptian children and adolescents. Clinical trials should be urgently conducted to test for causality and to evaluate the efficacy of vitamin D supplementation for prophylaxis and treatment of COVID-19 taking into account the VDR polymorphisms.

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“…12,26 Notably, a meta-analysis study indicated a higher risk (adjusted OR: 1.77, non-adjusted OR: 1.75) and higher severity (adjusted OR: 2.57, nonadjusted OR: 10.61) of SARS-CoV-2 infection in the vit D deficient group. 27 Indeed, growing evidence on the role of amplified inflammatory responses to SARS-CoV-2 in the development of MIS-C and the regulatory actions of vit D on pro-inflammatory cytokine signaling is considered to potentiate the possible role of vit D in MIS-C. 15 Moreover, low vit D levels were reported to be associated with an increased likelihood of developing Kawasaki disease (KD) as well as the risk of coronary outcomes in KD, which seems notable given that MIS-C shares considerable overlap with KD. 28,29 Vit D is considered to have important immunomodulatory and anti-inflammatory effects such as reduction in the plasma concentrations of pro-inflammatory cytokines produced as part of the cytokine storm in viral infections such as COVID-19, increase in concentrations of anti-inflammatory markers, regulation of adaptive immune response, and improvement of cellular immunity.…”

Section: Discussionmentioning

confidence: 99%

Serum Vitamin D Levels in Relation to Development of Multisystem Inflammatory Syndrome in Pediatric COVID-19

Zengın

Bal

Goren

et al. 2022

J Pediatr Infect Dis

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Objective The aim of the study is to evaluate vitamin D (vit D) levels in children with and without development of multisystem inflammatory syndrome in children (MIS-C) after coronavirus disease 2019 (COVID-19) and also between those with severe and moderate MIS-C. Methods This comprises retrospective data of 68 patients including 34 patients with MIS-C and admitted into the pediatric intensive care unit (MIS-C group) and 34 patients without MIS-C (non-MIS-C group) were analyzed for their presenting characteristics, serum vit D levels, ventilatory needs, and prognostic scores. Results Vit D levels were significantly lower in patients with versus without MIS-C [9 (2–18) vs. 19 (10–43) ng/mL, p <0.001], and also in patients with severe versus moderate MIS-C [7.5 (2–17) vs. 9 (5–18) ng/mL, p = 0.024]. Vit D deficiency (levels <12 ng/mL) was more common in the MIS-C versus non-MIS-C group (79.4 vs. 11.8%, p <0.001) and in severe versus moderate MIS-C (92.9 vs. 70.0%, p <0.001). The severe versus moderate MIS-C was associated with significantly higher levels of procalcitonin [7.6 (0.9–82) vs. 1.7 (0.2–42) ng/mL, p = 0.030] and troponin [211 (4.8–4,545) vs. 14.2 (2.4–3,065) ng/L, p = 0.008] and higher likelihood of reduced ejection fraction (75.0 vs. 15.4%, p = 0.004). Conclusion Our findings indicate the higher prevalence of vit D deficiency in pediatric COVID-19 patients with versus without MIS-C, as well as in those with severe versus moderate MIS-C. Higher troponin and procalcitonin levels and dyspnea at presentation seem also to be risk factors for severe MIS-C, more pronounced cardiac dysfunction, and poorer prognosis.

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Vitamin D status of children with paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS)

Cited by 15 publications

References 30 publications

The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children

The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children

Vitamin D deficiency and vitamin D receptor FokI polymorphism as risk factors for COVID-19

Serum Vitamin D Levels in Relation to Development of Multisystem Inflammatory Syndrome in Pediatric COVID-19

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