A new study published by the Journal of Intensive Care Medicine found that 72% of children admitted to the hospital for septic shock were severely vitamin D deficient. Furthermore, children who were severely vitamin D deficient experienced a decreased rate of shock reversal.
Septic shock is a life threatening condition in which an individual’s blood pressure becomes dangerously low as a result of sepsis, or blood poisoning. About 50% of septic shock cases end in mortality, making this condition the 13th leading cause of death in the US.
Vitamin D plays a key role in maintaining a healthy immune system. In fact, vitamin D produces proteins called cathelicidin and defensins which modulate innate and adaptive immunity against various infections, including sepsis. As a result, researchers theorize that vitamin D deficiency may contribute to the development of sepsis.
Research supports this relationship, with studies determining vitamin D deficiency significantly increases infection rate, sepsis and mortality risk among critically ill adults. However, the relationship between vitamin D status and sepsis among children remains unclear.
In a new study, researchers evaluated the relationship between vitamin D status and clinically significant outcomes in children with septic shock. Children were excluded from the study if they were over 17 years old, were currently supplementing with vitamin D, received bolus dosing of vitamin D to treat rickets, had been diagnosed with vitamin D deficiency within the last year or received steroid treatment for at least 10 days prior to admission in the the pediatric intensive care unit (PICU) for septic shock.
The study was conducted over 7 months. During this period, a total of 43 children admitted in the PICU met this criteria, and thus were included the analysis. The participants’ vitamin D levels were measured at admission and after 72 hours. Vitamin D deficiency was defined as levels below 10 ng/ml. The researchers observed the prevalence of severe vitamin D deficiency among the participants and compared vitamin D status to septic shock outcome.
Here is what the researchers found:
- A total of 72% of participants were severely vitamin D deficient at admission; this number decreased to 69% after 72 hours.
- Average vitamin D levels at admission decreased from 6.7 ng/ml to 4.5 ng/ml after 72 hours (p = 0.0003).
- A total of 74% of severely deficient patients experienced unresolved septic shock after 24 hours, while only 25% of those without severe vitamin D deficiency experienced unresolved septic shock (RR: 2.9 (1.09-8.08) p = 0.005).
- Severely vitamin D deficient children required more fluid boluses within the first 6 hours (p = 0.02).
- Severe vitamin D deficiency was associated with catecholamine refractory shock, a treatment resistant form of septic shock (p = 0.04).
- Children with severe vitamin D deficiency tended to be older (mean age of 4 years vs. 1.5 years), undernourished, experienced a longer duration of mechanical ventilation, ICU stay and an increased mortality rate; though, these relationships did not reach statistical significance.
The researchers concluded,
“The prevalence of severe vitamin D deficiency is high in children with septic shock admitted to pediatric intensive care unit. Severe vitamin D deficiency at admission seems to be associated with lower rates of shock reversal at 24 hours of ICU stay.”
They continued on to state,
“Our study provides preliminary data for planning interventional studies in children with septic shock and severe vitamin D deficiency.”
This study is limited by its small sample size and observational design. In order to determine if vitamin D supplementation improves the efficacy of septic shock treatment among children, randomized controlled trials are needed.
Sturges, M. & Cannell, JJ. Vitamin D deficiency associated with impaired reversal of septic shock among children. The Vitamin D Council Blog & Council, 2017.