COVID-19 Pozitif Semptomatik Çocukların D Vitamini Düzeyleri

Yıl 2021, Cilt: 19 Sayı: 1, 9 - 14, 09.04.2021

Elif Söbü Ayşe Karaaslan Ceren Çetin Yasemin Akın

Öz

Giriş: D vitamini bir vitamin olarak bilinmesine rağmen aynı zamanda bir prohormon görevi görür ve birçok işlevi vardır. Çalışmamızda COVID-19 enfeksiyonu tanısı ile izlenen pediyatrik hastalarda D vitamini düzeylerinin değerlendirilmesi amaçlandı.

Gereç ve Yöntem: Çalışmamız Mart-Nisan 2020 tarihlerinde İstanbul’da bir 3. basamak eğitim ve araştırma hastanesinde gerçekleştirildi. Semptomatik COVID-19 enfeksiyonu tanısı alan çocuklar çalışmaya dahil edildi. Demografik, klinik ve laboratuvar bulgular retrospektif olarak hasta dosyalarından kaydedildi.
Tüm hastaların D vitamini seviyeleri değerlendirildi. Kontrol grubu aynı mevsimde pediyatri polikliniğine rutin kontrol için başvuran sağlıklı çocuklardan oluşturuldu. Otuz COVID (+) ve 82 sağlıklı çocuk 25-OH vitamin D düzeyleri açısından karşılaştırıldı.

Bulgular: COVID-19 pozitif hastaların ortanca yaşı 11,8 (1,8-17,6), kontrol grubunun ortanca yaşı 12,7 (1-16,4) idi. Enfekte grupta 15 (%50) kız, 15 (%50) erkek, kontrol grubunda 39 (%47,5) kız, 43 (%52,5) erkek vardı. Yaş ve cinsiyet gruplar arasında farklılık göstermiyordu. COVID-19 pozitif grupta medyan D vitamini seviyesi 8,9 ng/ml (3-42 ng / ml), kontrol grubunda 18,5 ng/ml (9- 40,7 ng/ml) idi. COVID19 (+) grupta kontrol grubuna göre istatistiksel olarak anlamlı daha düşük D vitamini düzeyleri saptandı (p<0.001). COVID-19 pozitif grupta 19 hastaya BT yapıldı ve 19 hastanın 12’sinde (%63) viral pnömoni tespit edildi. Pnömoni (+) grupta 17,4 yaşında kız hasta ve 13,1 yaşında erkek hastada yaşa göre düşük fosfor seviyeleri (2,2 ve 2,4 mg/dl) bulundu. Her ikisinin de yüksek akımlı oksijen tedavisine ihtiyacı oldu, diğer vakaların hiçbiri oksijen tedavisine ihtiyaç duymadı.

Sonuç: Çalışmamız, Türkiye’de çocuklarda COVID-19 enfeksiyonu ile yatırılarak tedavi edilen olguların D vitamini düzeylerinin araştırıldığı ilk çalışmadır. Yatırılarak tedavi edilen COVID-19 (+) çocuklarda daha düşük D vitamini değerleri tespit ettik.

Anahtar Kelimeler

COVID-19,, vitamin D,, hypophosphatemia

Vitamin D Levels of COVID-19 Positive Sypmtomatic Pediatric Cases

Öz

Introduction:Vitamin D is known as a vitamin but also it acts as a prohormone and has many functions. The aim of this study is to investigate the vitamin D levels
in pediatric patients with COVID-19.

Materials and Methods: A retrospective study was performed in a tertiary education and research hospital in Istanbul, Turkey during the period of March to April 2020. Children diagnosed with symptomatic COVID-19 infection were included in the study. Demographic, clinical and laboratory findings were recorded from patient charts retrospectively. All patients investigated for vitamin D levels. Control group consists of healthy children admitted to pediatric outpatient units for routine check-up in the same season.Thirty children with COVID-19 and 82 healthy children included in this study were compared due to 25-OH vitamin D levels.

Results: The median age of COVID-19 positive patients was 11.8 (1.8-17.6) years and the median age of control group was 12.7 (1-16.4) years old. There were 15
(50%) females and 15 (50%) males in infected group and there were 39 (47.5%) females and 43 (52.5%) males control group. Age and gender did not differ among
the groups. Median vitamin D level in COVID-19 positive group was 8.9 ng/ml (3-42 ng/ml) and 18.5 ng/ml (9-40.7 ng/ml) in control group. We detected significantly
lower vitamin D values in COVID19(+) group when compared with control group (p<0.001). CT was performed 19 patients in COVID-19 positive group and viral
pneumonia was detected in 12(63%) of 19. pneumonia (+) group a 17.4-years-old female patient and a 13.1-years-old male patient had low phosphorus levels by age
(2.2 and 2.4 mg/dl). Both of them needed high flow oxygen therapy. None of the other cases needed oxygen therapy.

Conclusions: This is the first study to date has measured vitamin D levels in children with COVID-19 in Turkey. We detected significantly lower vitamin D
values in COVID-19(+) hospitalized children.

Anahtar Kelimeler

COVID-19,, vitamin D,, hypophosphatemia

Kaynakça

• 1. Monto AS. Medical reviews. Coronaviruses. Yale J Biol Med. 1974;47(4):234-51.
• 2. Commission WMH Report of clustering pneumonia of unknown etiology in Wuhan City (2019-2020).
• 3. https://www.who.int/docs/default source/coronaviruse/situationreports/ 20200311-sitrep-51 covid-19.pdf?sfvrsn=1ba62e57_10.
• 4. Jiehao Cai, Jing Xu, Daojiong Lin et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features, Clinical Infectious Diseases,, ciaa198, https://doi.org/10.1093/cid/ciaa198.
• 5. Liu W, Zhang Q, Chen J, et al Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. N Engl J Med 2020; 382:1370.
• 6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054.
• 7. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. doi:10.1001/jama.2020.2648.
• 8. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep 2020.
• 9. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; doi: 10.1542/peds.2020-0702. 10. Arihiro S, Nakashima A, Matsuoka M, et al. Randomized Trial of Vitamin D Supplementation to Prevent Seasonal Influenza and Upper Respiratory Infection in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;25(6):1088-1095. doi:10.1093/ibd/izy346.
• 11. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl) :1678S-88S. doi:10.1093/ ajcn/80.6.1678S.
• 12. Zhou YF, Luo BA, Qin LL. The association between vitamin D deficiency and community-acquired pneumonia: A metaanalysis of observational studies. Medicine 2019 (Baltimore) 98(38):e17252. doi:10.1097/MD.0000000000017252.
• 13. Takishita Y, Yasuda H, Shimizu M, et al. Formation of neutrophil extracellular traps in mitochondrial DNA-deficient cells. J Clin Biochem Nutr. 2020;66(1):15-23. doi:10.3164/jcbn.19-77.
• 14. Urashima M, Segawa T, Okazaki M et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr 2019; 91(5):1255-60.
• 15. Hong M, Xiong T, Huang J.et al. Association of vitamin D supplementation with respiratory tract infection in infants. Matern Child Nutr 2020; (September 2019):1-10.
• 16. Kuba K, Imai Y, Penninger JM. Angiotensin-converting enzyme 2 in lung diseases. Curr Opin Pharmacol. 2006;6(3):271-276. doi:10.1016/j.coph.2006.03.001.
• 17. Cui C, Xu P, Li G, et al. Vitamin D receptor activation regulates microglia polarization and oxidative stress in spontaneously hypertensive rats and angiotensin II-exposed microglial cells: Role of renin-angiotensin system. Redox Biol. 2019;26:101295. doi:10.1016/j.redox.2019.101295.
• 18. Ishii K, Takeuchi H, Fukunaga K. et al. Attenuation of lipopolysaccharide-induced acute lung injury after (pro)renin receptor blockade. Exp Lung Res 2015; 41:199-207. doi: 10.3109/01902148.2014.993444.
• 19. Molloy EJ., Murphy N. Vitamin D, Covid-19 and Children. Ir Med J 2020; 3;113(4):64.
• 20. Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality [published online ahead of print, 2020 May 6]. Aging Clin Exp Res. 2020;1-4. doi:10.1007/s40520-020-01570-8.
• 21. Munns CF, Shaw N, Kiely M. et al. Global consensus recommendations on prevention and management of nutritional rickets. Horm Res Paediatr 2016; 85(2):83-106.
• 22. Chowdhury R, Taneja S, Bhandari N. et al. Vitamin-D deficiency predicts infections in young north Indian children: A secondary data analysis. PLoS One 2017; 8;12(3):e0170509. doi: 10.1371/journal.pone.0170509. eCollection 2017.
• 23. Banajeh SM. Nutritional rickets and vitamin D deficiency- -association with the outcomes of childhood very severe pneumonia: a prospective cohort study. Pediatr Pulmonol 2009;44(12):1207-15. doi: 10.1002/ppul.21121
• 24. Yao J, Liu L, Chen G. et al. Two severe cases of H7N9 pneumonia patients with immunoneuroendocrine axis dysfunction and vitamin D insufficiency. BMC Infect Dis. 2014; 28;14:44. doi: 10.1186/1471-2334-14-44.
• 25. Urashima M, Segawa T, Okazaki M. et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr 2010; 91(5):1255-60. doi: 10.3945/ajcn.2009.29094.
• 26. Camargo CA Jr, Ganmaa D, Frazier AL. et al. Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics 2012; 130(3):e561-7. doi:10.1542/peds.2011-3029.
• 27. Ozhan B, Evrengul H, Yılmaz AS et al. Vitamin D status of children in a university hospital in west turkey. HK J Pediatry 2016;21:251-6.
• 28. Akman AO, Tumer L, Hasanoğlu A et al. The frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int 2011;53:968-73.
• 29. Silva MC, Furlanetto TW. Does serum 25-hydroxyvitamin D decrease during acute-phase response? A systematic review. Nutr Res 2015; 35(2):91-6. doi:10.1016/j.nutres.2014.12.008.
• 30. Ebadi M, Montano-Loza AJ. Perspective: improving vitamin D status in the management of COVID-19. Eur J Clin Nutr 2020;12. doi: 10.1038/s41430-020-0661-0.