MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK.
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
BMJ Open. 2019 May 22;9(5):e027666. doi: 10.1136/bmjopen-2018-027666.
To estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and investigate its association with mortality in children with acute or critical conditions.
Systematic review and meta-analysis of observational studies.
PubMed, OVID, Google Scholar and the Cochrane Library searched until 21 December 2018.
Studies of children hospitalised with acute or critical conditions who had blood 25(OH)D levels measured.
We obtained pooled prevalence estimates of 25(OH)D deficiency and ORs for mortality. We calculated 95% CI and prediction intervals and investigated heterogeneity and evidence of small-study effects.
Fifty-two studies were included. Of 7434 children, 3473 (47.0%) were 25(OH)D deficient (<50 nmol/L). The pooled prevalence estimate of 25(OH)D deficiency was 54.6% (95% CI 48.5% to 60.6%, I=95.3%, p<0.0001). Prevalence was similar after excluding smaller studies (51.5%). In children with sepsis (18 studies, 889 total individuals) prevalence was 64.0% (95% CI 52.0% to 74.4%, I=89.3%, p<0.0001) and 48.7% (95% CI 38.2% to 59.3%; I=94.3%, p<0.0001) in those with respiratory tract infections (RTI) (25 studies, 2699 total individuals). Overall, meta-analysis of mortality (18 cohort studies, 2463 total individuals) showed increased risk of death in 25(OH)D deficient children (OR 1.81, 95% CI 1.24 to 2.64, p=0.002, I=25.7%, p=0.153). Four (22.0%) of the 18 studies statistically adjusted for confounders. There were insufficient studies to meta-analyse sepsis and RTI-related mortality.
Our results suggest that 25(OH)D deficiency in acute and critically ill children is high and associated with increased mortality. Small-study effects, reverse causation and other biases may have confounded results. Larger, carefully designed studies in homogeneous populations with confounder adjustment are needed to clarify the association between 25(OH)D levels with mortality and other outcomes.
CRD42016050638.
评估急性或危重症患儿维生素 D 缺乏的发生率，并探讨其与死亡率的关系。
对观察性研究进行系统回顾和荟萃分析。
PubMed、OVID、Google Scholar 和 Cochrane 图书馆检索至 2018 年 12 月 21 日。
研究对象为患有急性或危重症并接受血液 25-羟维生素 D（25（OH）D）水平检测的患儿。
我们获得了维生素 D 缺乏的汇总发生率和死亡率的比值比（OR）。我们计算了 95%置信区间（CI）和预测区间，并对异质性和小样本研究效应进行了评估。
共纳入 52 项研究。在 7434 名患儿中，3473 名（47.0%）患儿 25（OH）D 缺乏（<50 nmol/L）。维生素 D 缺乏的汇总发生率为 54.6%（95% CI 48.5%60.6%，I=95.3%，p<0.0001），排除较小的研究后发生率相似（51.5%）。在脓毒症患儿（18 项研究，889 例）中，维生素 D 缺乏的发生率为 64.0%（95% CI 52.0%74.4%，I=89.3%，p<0.0001），呼吸道感染（RTI）患儿（25 项研究，2699 例）的发生率为 48.7%（95% CI 38.2%59.3%；I=94.3%，p<0.0001）。总体而言，18 项队列研究（2463 例）的死亡率荟萃分析显示，维生素 D 缺乏患儿死亡风险增加（OR 1.81，95% CI 1.242.64，p=0.002，I=25.7%，p=0.153）。其中 4 项（22.0%）研究对混杂因素进行了统计学调整。没有足够的研究来对脓毒症和 RTI 相关死亡率进行荟萃分析。
本研究结果表明，急性和危重症患儿维生素 D 缺乏的发生率较高，且与死亡率升高相关。小样本研究效应、反向因果关系和其他偏倚可能影响了研究结果。需要更大规模、精心设计的同质人群研究，并对混杂因素进行调整，以明确维生素 D 水平与死亡率及其他结局的关系。
CRD42016050638。
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