Vitamin D Status at the Time of Hospitalization for Bronchiolitis and Its Association with Disease Severity.
J Pediatr. 2018 Sep 20. pii: S0022-3476(18)31096-5. doi: 10.1016/j.jpeds.2018.07.097. [Epub ahead of print]
Vo P1, Koppel C2, Espinola JA3, Mansbach JM4, Celedón JC5, Hasegawa K3, Bair-Merritt M6, Camargo CA Jr 3.
1 Department of Pediatrics, Boston Medical Center, Boston, MA. phuong.vo at bmc.org.
2 Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
3 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
4 Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
5 Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
6 Department of Pediatrics, Boston Medical Center, Boston, MA.
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PDF is available free at Sci-Hub 10.1016/j.jpeds.2018.07.097
To investigate the association between circulating 25-hydroxyvitamin D [25(OH)D] status at admission and disease severity among infants hospitalized for bronchiolitis and to determine whether the association differs by the form of 25(OH)D-total, bioavailable or free 25(OH)D.
We conducted a 17-center prospective cohort study of 1016 US infants <12 months old hospitalized with bronchiolitis. Vitamin D status was defined by total 25(OH)D levels, and by calculated levels of bioavailable and free 25(OH)D. Bronchiolitis severity was defined by requirement for intensive care and hospital length-of-stay (LOS). Logistic and Poisson regression were used for unadjusted and multivariable analyses.
The median age of hospitalized infants was 3.2 months (IQR 1.6-6.0). The median total 25(OH)D was 26.5 ng/mL (IQR 18.0-33.1); 298 (29%) infants had total 25(OH)D <20 ng/mL. In multivariable models, infants with total 25(OH)D <20 ng/mL had higher risk of requiring intensive care (aOR 1.72, 95% CI 1.12-2.64) and longer LOS (adjusted rate ratio 1.39, 95% CI 1.17-1.65) compared with infants with total 25(OH)D ≥30 ng/mL. Infants with the lowest tertile of bioavailable 25(OH)D, compared with those with the highest tertile, had longer LOS (adjusted rate ratio 1.32, 95% CI 1.07-1.62); admission to the intensive care unit was not statistically significant in the adjusted model (aOR 1.39, 95% CI 0.96-2.64). Free 25(OH)D level was not associated with severity of bronchiolitis in either unadjusted or adjusted models.
CONCLUSION: In a large, multicenter cohort of US infants hospitalized for bronchiolitis, infants with total 25(OH)D <20 ng/mL had increased risk of intensive care and longer hospital LOS.
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