Kubsad Payal, Ravikiran S R, Bhat Kamalakshi G, Kamath Nutan, Kulkarni Vaman, Manjrekar Poornima A, Acharya Sahana D
Department of Pediatrics, Kasturba Medical College, Mangaluru, Karnataka, India.
Department of Pediatrics, KMC Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Indian J Crit Care Med. 2021 Aug;25(8):923-927. doi: 10.5005/jp-journals-10071-23913.
Critically ill Indian children have a higher prevalence of vitamin D deficiency. However, there is not much data available on the subgroup with sepsis. It has been reported that there is an impaired response of parathyroid hormone (PTH) to vitamin D deficiency in critically ill children and adults. Hence, we also sought to analyze the PTH response to vitamin D among the subgroup of critically ill children with sepsis. Vitamin D and PTH levels of 84 critically ill children with sepsis (cases) and 84 controls were compared between November 2018 and February 2020. Hypovitaminosis D was defined as levels <30 ng/mL. The median (IQR) of vitamin D for cases was 26 (21.30-29.95) ng/mL and that for controls 39.3 (33.65-50.2) ng/mL; <0.001. Cases had a higher prevalence of hypovitaminosis D as compared to controls (79.7 vs 9.5%; <0.001). Among the cases, mortality was 24.6% in the 65 children with hypovitaminosis D and 10.5% in those with sufficient vitamin D; the differences were not statistically significant ( = 0.339). There were no significant differences in the duration of pediatric intensive care unit (PICU) stay, serum calcium, PTH, and disease severity among the aforementioned groups. Out of the 65 children with hypovitaminosis D, only 9 (13.8%) were PTH responders. There were no statistically significant differences in mortality, the PICU stay, or disease severity at admission between PTH responders and nonresponders. Hypovitaminosis D was more prevalent among critically ill children with sepsis compared to controls. Parathyroid gland response to hypovitaminosis D was impaired in children with sepsis. Kubsad P, Ravikiran SR, Bhat KG, Kamath N, Kulkarni V, Manjrekar PA, . Hypovitaminosis D and Parathyroid Hormone Response in Critically Ill Children with Sepsis: A Case-control Study. Indian J Crit Care Med 2021;25(8):923-927.
印度重症儿童维生素D缺乏的患病率较高。然而，关于脓毒症亚组的数据并不多。据报道，重症儿童和成人中甲状旁腺激素（PTH）对维生素D缺乏的反应受损。因此，我们还试图分析重症脓毒症儿童亚组中PTH对维生素D的反应。在2018年11月至2020年2月期间，比较了84例重症脓毒症儿童（病例组）和84例对照组的维生素D和PTH水平。维生素D缺乏症定义为水平<30 ng/mL。病例组维生素D的中位数（IQR）为26（21.30 - 29.95）ng/mL，对照组为39.3（33.65 - 50.2）ng/mL；P<0.001。与对照组相比，病例组维生素D缺乏症的患病率更高（79.7%对9.5%；P<0.001）。在病例组中，65例维生素D缺乏症儿童的死亡率为24.6%，维生素D充足的儿童死亡率为10.5%；差异无统计学意义（P = 0.339）。上述各组在儿科重症监护病房（PICU）住院时间、血清钙、PTH和疾病严重程度方面无显著差异。在65例维生素D缺乏症儿童中，只有9例（13.8%）是PTH反应者。PTH反应者和无反应者在死亡率、PICU住院时间或入院时疾病严重程度方面无统计学显著差异。与对照组相比，重症脓毒症儿童中维生素D缺乏症更为普遍。脓毒症儿童甲状旁腺对维生素D缺乏症的反应受损。库布萨德P，拉维基兰SR，巴特KG，卡马特N，库尔卡尼V，曼杰雷卡尔PA等。重症脓毒症儿童维生素D缺乏症和甲状旁腺激素反应：一项病例对照研究。《印度重症医学杂志》2021；25（8）：923 - 927。
