Research Snapshot: COVID-19 Epidemiology/Outcomes
138: Vitamin D Levels in Children With COVID-19 Admitted to the PICU
Introduction/Hypothesis: Vitamin-D (Vit-D) has an important immunomodulatory role and its deficiency has been linked to increased viral respiratory infections in the pediatric population. Recent adult studies have shown an association between lower Vit-D levels and mortality in COVID-19. Low Vit-D levels are common in children with obesity and associated with enhanced systemic inflammation.
Methods: This is an IRB approved, retrospective case series of children with COVID-19 admitted to a tertiary pediatric intensive care unit (PICU), describing the clinical features and 25-hydroxy-Vit-D levels. Charts were reviewed and pertinent data collected. Deidentified data were analyzed using SPSS v.26. Categorical data are presented as frequencies and percentages. Continuous data presented as median with interquartile range (IQR).
Results: A total of 14 COVID-19 patients who had 25-OH Vit D levels measured were reviewed. All patients had MIS-C (fever, inflammation, and 2 or more organ involvement). Demographic data included, females 50% (n=7), Hispanics 64.3% (n=9), whites 78.6% (n=11), and blacks, 21.4% (n=3). The median age was 15 (IQR 4.83) with 64% (n=9) teens. Overweight or obese was present in 71.4% (n=10). Median BMI was 31.2 (IQR18.31). Vit-D deficiency (level<30 ng/ml) was present in 71.4% (n=10). Median Vit-D level was 22.5 ng/mL (range 12.8-45). Premorbid conditions were present in 64.3% (n=9) in all and 70% (n=7) in those who were Vit-D deficient. Asthma (n=4) and seizure disorder (n=3) were the most common premorbid conditions. Pulmonary failure (defined as need for any respiratory support) was seen in 50% (n=7) of all cases and 86% (n=6) of them were Vit-D deficient. PARDS (SF ratio<264) was present in 36% (n=5) patients and 80% (n=4) of those were Vit-D deficient. Median D-dimer level was 1.67 (IQR 6.7). Anticoagulation was started in 93% (n=13). Lymphopenia was seen in 87% cases with median lowest lymphocyte count of 767 (IQR 574). Mean hospital stay was 10.8 (range 3-29) days. One child died. All children with low Vit-D levels were given supplementation.
Conclusions: Majority of COVID-19 pediatric patients needing ICU admission were obese, Vit-D deficient adolescents. Based on these findings in our PICU cohort, it is prudent to screen for Vit-D levels and supplement those with low levels.Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.