Vitamin D Deficiency and Critical Illness
The Indian Journal of Pediatrics, Nov 2015, V 82, Issue 11, pp 991-995
Shailender Prasad, Dinesh Raj , Sumbul Warsi, Sona Chowdhary
Objective
To determine the prevalence of vitamin D deficiency in critically ill children and assess its association with severity of illness and other outcomes associated with critical illness.
Methods
Eighty children aged 2mo to 12y, admitted with medical conditions to the pediatric intensive care unit of a tertiary care hospital were enrolled in this prospective observational study. Vitamin D levels were obtained during the first hour of stay. Severity score was assessed using the Pediatric Risk of Mortality III (PRISM III) within first 12 h of admission.
Results
Vitamin D deficiency {25-hydroxy vitamin D [25(OH)D] levels < 20 ng/ml} was observed in 67 (83.8 %) children. Vitamin D deficient children had significantly higher PRISM III score compared to vitamin D sufficient children [10 (IQR:5–15) vs. 6 (IQR:3–7); p 0.0099]. 25(OH)D levels had a significant negative correlation with PRISM III score (ρ -0.3747; p 0.0006).
Conclusions
Vitamin D appears to be of utmost importance in critically ill children.
Publisher wants $40 for the PDF
See also VitaminDWiki
Pages listed in BOTH of the categories Infant/Child and Trauma/Surgery
- Sepsis is fought by Vitamin D in 9 ways – Feb 2023
- Fewer drugs needed after cardiac surgery if higher levels of vitamin D (Chinese children) – July 2021
- 3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020
- PICU children with low vitamin D levels have worse health scores (PRISM-III) – Feb 2020
- Vitamin D levels dropped 42 percent immediately after pediatric cardiac surgery – Dec 2019
- Septic children have low Vitamin D (54 studies, ignored Vitamin D Receptor) – meta-analysis April 2019
- Candida infections in PICU reduced by Vitamin D in yogurt – RCT Feb 2019
- Children entering ICU with low vitamin D were 3.5 X more likely to have a poor ICU score– Oct 2018
- Critically ill children with low vitamin D: 2.5 X more likely to die or stay 2 days longer - meta-analysis Nov 2017
- Micronutrients (such as Vitamin D) for critically ill children – review Oct 2017
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- Vitamin D deficiency in pediatric critical illness: Time to move on from observational studies – Nov 2016
- Low vitamin D in Pediatric ICU – 5 times more ill (morbidity) – Spanish Nov 2016
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
- Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial
- Congenital Heart problems - vitamin D levels drop even lower after surgery, loading dose probably required - thesis 2015
- Infant in ICU much more likely to die if low vitamin D – Nov 2015
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- Hospitalization consumes vitamin D in children – March 2014
- Congenital heart surgery dropped vitamin D levels by 40 percent – July 2013
- Vitamin D deficient children stayed in ICU almost 2 days longer – Sept 2012
See PRISM-III abstract from the web
The Pediatric Risk of Mortality III- -Acute Physiology Score (PRISM III-APS): a method of assessing physiologic instability for pediatric intensive care unit patients.
J Pediatr. 1997 Oct;131(4):575-81.
Pollack MM1, Patel KM, Ruttimann UE.
OBJECTIVE:
To develop a physiology-based measure of physiologic instability for use in pediatric patients that has an expanded scale compared with the Pediatric Risk of Mortality (PRISM) III score.
STUDY DESIGN:
Data were collected from consecutive admissions to 32 pediatric ICUs (11,165 admission, 543 deaths). Patient-level data included physiologic data, outcomes, descriptive information, and diagnoses. Physiologic data included the most abnormal values in the first 24 hours of pediatric ICU stay from 27 variables. Initially, ranges of each physiologic variable were evaluated for their association with mortality. A multi-variate logistic regression analysis was used to determine the final variables and their ranges. Integer scores reflecting the relative contribution to mortality risk were assigned to the variable ranges.
RESULTS:
A total of 59 ranges of 21 physiologic variables were selected. This score is called the Pediatric Risk of Mortality III- -Acute Physiology Score (PRISM III-APS). Mortality increased as the PRISM III-APS score increased. Most patients have PRISM III-APS scores less than 10, and these patients have a mortality risk of less than 1%. At the other extreme, the mortality rate of the 137 patients with a PRISM III-APS score of greater than 80 was greater than 97%.
CONCLUSION:
The PRISM III-APS score is an expanded measure of physiologic instability that has been validated against mortality. Compared with PRISM III, PRISM III-APS should be more sensitive to small changes in physiologic status.
PMID: 9386662
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So: The abstract says PRISM III scores ranging from 0 to 10 = 1% averge chance of death
Estimate chance of death = 2 % if PRISM = 10
Estimate chance of death = .6 % if that if PRISM = 6
If so, then having < 20 ng would perhaps tripple ("much more") the PICU infant chance of death