Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
Pediatrics. 2012 Sep;130(3):421-8. doi: 10.1542/peds.2011-3328. Epub 2012 Aug 6.
Vitamin D influences cardiovascular and immune function. We aimed to establish the prevalence of vitamin D deficiency in critically ill children and identify factors influencing admission 25-hydroxy vitamin D (25(OH)D) levels. We hypothesized that levels would be lower with increased illness severity and in children with serious infections.
Participants were 511 severely or critically ill children admitted to the PICU from November 2009 to November 2010. Blood was collected near PICU admission and analyzed for 25(OH)D concentration by using Diasorin radioimmunoassay.
We enrolled 511 of 818 (62.5%) eligible children. The median 25(OH)D level was 22.5 ng/mL; 40.1% were 25(OH)D deficient (level <20 ng/mL). In multivariate analysis, age and race were associated with 25(OH)D deficiency; summer season, vitamin D supplementation, and formula intake were protective; 25(OH)D levels were not lower in the 238 children (46.6%) admitted with a life-threatening infection, unless they had septic shock (n = 51, 10.0%) (median 25(OH)D level 19.2 ng/mL; P = .0008). After adjusting for factors associated with deficiency, lower levels were associated with higher admission day illness severity (odds ratio 1.19 for a 1-quartile increase in Pediatric Risk of Mortality III score per 5 ng/mL decrease in 25(OH)D, 95% confidence interval 1.10-1.28; P < .0001).
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.
维生素 D 会影响心血管和免疫功能。本研究旨在确定危重症患儿维生素 D 缺乏的发生率，并确定影响入院时 25-羟维生素 D（25（OH）D）水平的因素。我们假设疾病严重程度越高，合并严重感染的患儿 25（OH）D 水平越低。
研究对象为 2009 年 11 月至 2010 年 11 月期间收入儿童重症监护病房（PICU）的 511 例严重或危重症患儿。患儿入院时采集血液标本，采用 Diasorin 放射免疫法分析 25（OH）D 浓度。
本研究共纳入 818 例符合条件的患儿中的 511 例（62.5%）。患儿 25（OH）D 中位数水平为 22.5ng/ml，40.1%患儿 25（OH）D 缺乏（水平<20ng/ml）。多因素分析显示，年龄和种族与 25（OH）D 缺乏相关；夏季、维生素 D 补充和配方奶摄入起保护作用；在因危及生命的感染而入院的 238 例患儿（46.6%）中，25（OH）D 水平并未降低，除非他们合并感染性休克（n=51，10.0%）（中位数 25（OH）D 水平为 19.2ng/ml；P=0.0008）。在校正与缺乏相关的因素后，较低的 25（OH）D 水平与入院日疾病严重程度较高相关（每降低 5ng/ml 的 25（OH）D，儿科危重病风险评分Ⅲ（Pediatric Risk of Mortality III score）增加 1 个四分位，优势比为 1.19，95%置信区间为 1.10-1.28；P<0.0001）。
我们发现危重症患儿维生素 D 缺乏的发生率较高。鉴于维生素 D 在骨骼发育和免疫功能中的作用，我们建议对有维生素 D 缺乏危险因素的危重症患儿进行筛查，并实施有效的补充策略。
