Is There Any Relationship between Clinical Progress and Vitamin-D Levels in Critically Ill Children?

Öz

Introduction: Vitamin-D is a hormone that affects infections, the autoimmune system, the cardiovascular system, and the central nervous system; therefore, it is considered important for critically ill patients. This study aimed to examine the relationship between vitamin-D levels and Paediatric Risk of Mortality (PRISM)III score and mortality rates in critically ill children. Method: A total of 200 patients who were admitted to Atatürk University Paediatric Intensive Care Unit between January 2016 to January 2017 were included in this study. Demographic data, PRISM III score, serum calcium, phosphorus, alkaline phosphatase, parathormone, and 25-Hydroxy-Vitamin-D [25(OH)D] levels were recorded. 25(OH)D levels were grouped as deficiency (below 12 ng/ml), insufficiency (12-20 ng/ml), sufficiency (20-100 ng/ml), and excess (above 100 ng/ml). Results: Vitamin-D levels of 23.5% of the patients were deficient, 24.5% were insufficient, and 52% were sufficient. A negative correlation was found between vitamin-D and age (r=-0.42, p<0.01). PRISM III score was found to be lower in patients with sufficient vitamin-D (p<0.01). Although the mortality rate of cases with vitamin-D deficiency was higher, it was not found to be significant. No significant relationship was found between vitamin-D level and duration of hospitalization, duration of mechanical ventilation, chronic disease status, or vasopressor need. Conclusion: PRISM scoring system is a scoring system frequently used in paediatric intensive care units to predict mortality. The higher PRISM III score in patients with insufficient or deficient vitamin-D levels may suggest that vitamin-D insufficiency or deficiency is a risk factor for mortality.

Anahtar Kelimeler

• vitamin D
• mortality
• PRISM III
• critical ill children

Teşekkür

We thank Assoc. Prof. Pelin Çelik, for her invaluable comments on the manuscript.

Çocuk Yoğun Bakım Ünitesinde Yatan Kritik Hastalığı Olan Çocuklarda D Vitamini Düzeyi ile Klinik İzlem Arasında İlişki Var mı?

Öz

Giriş: D vitamini enfeksiyonlar, otoimmün sistem, kardiyovasküler sistem ve merkezi sinir sistemi üzerine etki gösteren bir hormondur; bu nedenle kritik hastalar için önemli olduğu düşünülmektedir. Bu çalışmada, kritik hastalığı olan çocuklardaki D vitamini düzeyi ile Pediatrik Mortalite Riski (PRISM)III skoru ve mortalite oranları arasındaki ilişkinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya Atatürk Üniversitesi Çocuk Yoğun Bakım Ünitesine Ocak 2016 ile Ocak 2017 tarihleri arasında yatırılan toplamda 200 hasta dahil edildi. Demografik veriler, PRISM III skoru, serum kalsiyum (Ca), fosfor (P), alkalen fosfataz (ALP), parathormon (PTH) ve 25-Hidroksi-Vitamin-D [25(OH)D] seviyeleri kaydedildi. 25(OH)D seviyeleri eksiklik (12 ng/ml altı), yetersizlik (12-20 ng/ml), yeterlilik (20-100 ng/ml) ve fazlalık olarak gruplandırıldı (100 ng/ml üzeri). Bulgular: Hastaların %23,5'inin D vitamini düzeyi eksik, %24,5’inin yetersiz, %52’sinin yeterliydi. D vitamini ile yaş arasında negatif korelasyon saptandı (r=-0,42, p<0,010). D vitamini yeterli olan hastalarda PRISM III skoru daha düşük bulundu (p<0,010). D vitamini eksikliği olan hastaların ölüm oranı daha yüksek olmakla beraber anlamlı bulunmadı. D vitamini düzeyi ile hastanede yatış süresi, mekanik ventilatör süresi, kronik hastalık durumu ya da vazopressör ihtiyacı arasında anlamlı ilişki saptanmadı. Sonuçlar: PRISM skorlama sistemi mortaliteyi öngörme açısından çocuk yoğun bakım ünitelerinde sıklıkla kullanılan bir skorlama sistemidir. D vitamini seviyesi yetersiz veya eksik olan hastalarda PRISM III skorunun daha yüksek olması, D vitamini yetersizliği veya eksikliğinin mortalite için bir risk faktörü olduğunu düşündürebilir.

Anahtar Kelimeler

• D vitamini
• Mortalite
• PRISM III
• Kritik hasta çocuk

Kaynakça

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