Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, Zhejiang Province.
Department of Pediatric Infectious Diseases, Xinhua Hospital, Shanghai Jiaotong University, P.R. China.
Medicine (Baltimore). 2021 Jan 15;100(2):e23827. doi: 10.1097/MD.0000000000023827.
Sepsis leads to the high mortality in critically ill infants and children. It is still controversial whether vitamin D deficiency was associated with the incidence of sepsis. Thus we designed the systematic review and meta-analysis.
The Ovid Medline, Embase, PubMed, and Cochrane library were systematically searched until April 5, 2020. The 25 hydroxyvitamin D (25-OHD) level was recorded and set 20 ng/mL as cut-off in cohort study to divide the lower and higher 25-OHD group. The odds ratio (OR) and 95% confidence intervals (CIs) were calculated for comparing the impact of vitamin D deficiency on the incidence of sepsis in critically ill children.
A total of 27 studies were included with 17 case-control studies and 10 cohort studies. In those case-control studies, the maternal 25-OHD level and neonatal 25-OHD level in sepsis group was significant lower than non-sepsis group (P < .001). The percentage of severe vitamin D deficiency was significant higher in sepsis group comparing to non-sepsis group (odds ratio [OR] = 2.66, 95% CI = 1.13-6.25, P < .001). In those cohort studies, the incidence of sepsis in lower 25-OHD group was 30.4% comparing with 18.2% in higher 25-OHD level group. However, no statistical significant difference in terms of mechanical ventilation rate and 30-day mortality.
We demonstrated that critically ill infants and children with sepsis could have a lower 25-OHD level and severe vitamin D deficiency comparing to those without sepsis. Future studies should focus on the association of vitamin D supplement and the occurrence of sepsis in critically ill children.
败血症可导致危重症婴儿和儿童的高死亡率。维生素 D 缺乏是否与败血症的发生有关仍存在争议。因此，我们设计了系统评价和荟萃分析。
系统检索了 Ovid Medline、Embase、PubMed 和 Cochrane 图书馆，检索时间截至 2020 年 4 月 5 日。记录 25 羟维生素 D（25-OHD）水平，并在队列研究中将 20ng/mL 设为截断值，将 25-OHD 水平较低和较高的组分为两组。计算比值比（OR）和 95%置信区间（CI），以比较维生素 D 缺乏对危重症儿童败血症发生率的影响。
共纳入 27 项研究，其中 17 项为病例对照研究，10 项为队列研究。在这些病例对照研究中，败血症组产妇和新生儿的 25-OHD 水平显著低于非败血症组（P<0.001）。败血症组严重维生素 D 缺乏的比例显著高于非败血症组（OR=2.66，95%CI=1.13-6.25，P<0.001）。在这些队列研究中，25-OHD 水平较低组的败血症发生率为 30.4%，而 25-OHD 水平较高组的败血症发生率为 18.2%。然而，两组间机械通气率和 30 天死亡率无统计学差异。
我们发现与无败血症的患儿相比，败血症患儿的 25-OHD 水平和严重维生素 D 缺乏更为常见。未来的研究应关注维生素 D 补充与危重症儿童败血症发生的关系。
