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Infant in ICU much more likely to die if low vitamin D – Nov 2015

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

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.

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.

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).

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

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.

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.
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.
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%.
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

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