Skip to main content

Volume 15 Supplement 3

Sepsis 2011

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

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.

References

  1. 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.0b013e318206ccdf

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  2. 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.21089

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to K Madden.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Madden, K., Feldman, H., Smith, E. et al. Septic shock and vasopressor requirement is associated with lower vitamin D levels in critically ill children. Crit Care 15, P21 (2011). https://doi.org/10.1186/cc10390

Download citation

Keywords

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