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Critically ill children with low vitamin D: 2.5 X more likely to die or stay 2 days longer - meta-analysis Nov 2017

Vitamin D deficiency in critically ill children: a systematic review and meta-analysis

Critical Care201721:287, https://doi.org/10.1186/s13054-017-1875-y
James Dayre McNally, Nassr Nama, Katie O’Hearn, Margaret Sampson, Karin Amrein, Klevis Iliriani, Lauralyn McIntyre, Dean Fergusson and Kusum Menon

VitaminDWiki Summary

Vitamin D < 20 ng in Pediatric Intensive Care Unit

Increased Risk
PICU length of stay 2.0 more days
Infection 2.5 X
Mechanical Ventilator1.9 X
Vasopressor use
reduce blood pressure
2.2 X
Mortality 2.5 X

items in BOTH of categories: Infant-Child and Trauma/Surgery

Restoring Vitamin D in the PICU as soon as possible is vital
   Not mentioned by the meta-analysis on this page

Not Mentioned: The vitamin D used must be able to quickly get to the cells
Injection and IV are both very quick, and do not need the gut to digest it or even be working
Note: Most IV provide only 200 IU of Vitamin D per day
People with poor guts getting nutrition via IV had poor oral Vitamin D bio-availability – May 2017


 Download the PDF from VitaminDWiki

1.8 X more likely to have low Vitamin D (< 20 ng)

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1.6 X more likely to die (all countries) if low Vitamin D

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Background
Vitamin D deficiency (VDD) has been hypothesized not only to be common but also to represent a potentially modifiable risk factor for greater illness severity and clinical outcome during critical illness. The objective of this systematic review was to determine the frequency of VDD in pediatric critical illness and its association with clinical outcomes.

Methods
MEDLINE, Embase, and CENTRAL were searched through December 12, 2016, with no date or language restrictions. The primary objective was to estimate the prevalence of VDD in the pediatric intensive care unit (PICU) and compare vitamin D status with healthy control populations. Secondary objectives were to evaluate whether VDD is associated with mortality, increased illness severity, PICU interventions, and patient clinical course. Random effects meta-analysis was used to calculate pooled VDD event rate, compare levels with those of control subjects, and evaluate for associations between VDD and clinical outcome.

Results
Among 2700 citations, 17 studies meeting study eligibility were identified. The studies reported a total of 2783 critically ill children and had a median sample size of 120 (range 12–511). The majority of studies used a 25-hydroxyvitamin D [25(OH)D] level less than 50 nmol/L to define VDD, and the pooled VDD prevalence was 54.8 (95% CI 45.4–63.9). Average 25(OH)D levels were significantly lower in PICU patients than in healthy control subjects (pooled difference −17.3 nmol/L, 95% CI −14.0 to −20.6). In a meta-analysis calculation, we found that VDD was associated with increased mortality (OR 1.62, 95% CI 1.11–2.36), illness severity, and need for PICU interventions.

Conclusions
Approximately 50% of critically ill children have VDD at the time of PICU admission, defined as a blood total 25(OH)D concentration under 50 nmol/L. VDD was further determined to be associated with greater illness severity, multiple organ dysfunction, and mortality in the PICU setting. Clinical trials are required to determine if optimization of vitamin D status improves patient outcome.

Trial registration: PROSPERO, CRD42016026617. Registered on 11 January 2016.

Created by admin. Last Modification: Friday November 24, 2017 17:38:10 UTC by admin. (Version 14)

Attached files

ID Name Comment Uploaded Size Downloads
8808 Criticall ill F4.jpg admin 24 Nov, 2017 01:52 54.95 Kb 18
8807 Criticall ill F3.jpg admin 24 Nov, 2017 01:52 69.99 Kb 19
8806 Criticall ill F2.jpg admin 24 Nov, 2017 01:52 69.30 Kb 17
8805 Critically ill children meta-analysis.pdf PDF 2017 admin 24 Nov, 2017 01:51 1.02 Mb 17
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