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Volume 15 Supplement 3

Sepsis 2011

  • Poster presentation
  • Open Access

Septic shock and vasopressor requirement is associated with lower vitamin D levels in critically ill children

  • 1, 2,
  • 3, 4, 5,
  • 1,
  • 3, 5, 6,
  • 1,
  • 1,
  • 7,
  • 1 and
  • 1, 2
Critical Care201115 (Suppl 3) :P21

https://doi.org/10.1186/cc10390

  • Published:

Keywords

  • Septic Shock
  • Sequential Organ Failure Assessment
  • Illness Severity
  • Lower Vitamin
  • Collect Blood Sample

Introduction

Vitamin D plays an important role in immune and cardiovascular function. There is evidence that low 25-hydroxyvitamin D (25(OH)D) levels are associated with an increased risk of life-threatening infections [1, 2]. Our objective was to determine the prevalence of 25(OH)D deficiency (<20 ng/ml) in critically ill children and to identify any association with illness severity and infection.

Methods

From November 2009 to November 2010, we collected blood samples and clinical data on children (<21 years old) near the time of admission to the pediatric ICU, excluding those admitted for short-term monitoring. We measured plasma 25(OH)D concentrations in plasma using Diasorin radioimmunoassay on all subjects. Vasopressor requirement was measured using the cardiovascular component of the Sequential Organ Failure Assessment (CV-SOFA) score.

Results

Among 511/818 (62.5%) eligible children, 40.1% were 25(OH)D deficient (median level 22.5 ng/ml (IQR = 16.4, 31.3)). Children with a confirmed (n = 144, 28.2%) or suspected (n = 94, 18.1%) diagnosis of infection on admission did not have lower 25(OH)D levels overall, except for those presenting in severe septic shock (n = 51, median = 19.2 ng/ml, IQR = 12.6, 24.8; P = 0.0008). In the multivariate analysis, older age and nonwhite race were associated with vitamin D deficiency while summer season, vitamin D supplementation and formula intake were strongly protective. Patients with higher pediatric ICU admission day illness severity by PRISM-III score quartiles had lower vitamin D levels (OR = 1.19 per 5 ng/ml decrease in 25(OH)D, 95% CI = 1.10, 1.28, P < 0.0001) after adjusting for risk factors. When septic shock was added to this model, there was no effect on the association between 25(OH)D level and PRISM-III quartile (OR = 1.18 (95% CI = 1.09, 1.27, P < 0.0001)). There was also an inverse association between 25(OH)D level and maximal vasopressor use as measured by the CV-SOFA score in a multinomial regression model (OR = 1.13, 95% CI = 1.01, 1.27, P = 0.03). Including septic shock in the multivariable model did not affect the effect of vitamin D level (OR = 1.16, 95% CI = 1.02, 1.31, P = 0.02)) on CV-SOFA score.

Conclusion

The overall prevalence of vitamin D deficiency in critically ill children is high, and patients with severe septic shock had significantly lower vitamin D levels than the general population. This association between vitamin D and septic shock may be due to the cardiovascular effects of vitamin D or to increased severity of infection with diminished 25(OH)D levels. These results suggest a role for the vitamin D axis in sepsis and hemodynamic instability that deserves further investigation.

Authors’ Affiliations

(1)
Department of Anesthesia, Children's Hospital Boston, Boston, MA, USA
(2)
Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
(3)
Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA
(4)
The Clinical Research Program, Children's Hospital Boston, Boston, MA, USA
(5)
Department of Pediatrics, Harvard Medical School, Boston, MA, USA
(6)
Division of Adolescent and Young Adult Medicine, Children's Hospital Boston, Boston, MA, USA
(7)
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

References

  1. Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB: Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med 2011, 39: 671-677. 10.1097/CCM.0b013e318206ccdfPubMed CentralView ArticlePubMedGoogle Scholar
  2. McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg AM: Vitamin D deficiency in young children with severe acute lower respiratory infection. Pediatr Pulmonol 2009, 44: 981-988. 10.1002/ppul.21089View ArticlePubMedGoogle Scholar

Copyright

© Madden et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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