Vitamin A deficiency in critically ill children with sepsis

• Published in: Critical care (London, England) Vol. 23; no. 1; pp. 267 - 9
• Main Authors: Zhang, Xuepeng, Yang, Kaiying, Chen, Linwen, Liao, Xuelian, Deng, Liping, Chen, Siyuan, Ji, Yi
• Format: Journal Article
• Language: English
• Published: London BioMed Central 01.08.2019; BioMed Central Ltd; BMC
• Subjects: Adolescent; Biomarkers - analysis; Biomarkers - blood; Care and treatment; Child; Child health; Child, Preschool; Children; China - epidemiology; Critical Care Medicine; Critical Illness - epidemiology; Critically ill children; Diagnosis; Emergency Medicine; Female; Health; Humans; Infant; Infection; Intensive; Male; Medicine; Medicine & Public Health; Mortality; Pediatric intensive care; Pediatric surgery; Pediatrics; Prospective Studies; Sepsis; Sepsis - blood; Sepsis - complications; Sepsis - physiopathology; Septic shock; Shock; Surgery; Vitamin A; Vitamin A - analysis; Vitamin A - blood; Vitamin A deficiency; Vitamin A Deficiency - physiopathology; Vitamins; China; Pediatrics; Vitamin A; Sepsis; Vitamin A deficiency
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1466-609X
• DOI: 10.1186/s13054-019-2548-9

Background Data that indicate vitamin A status in critically ill children with sepsis are sparse. The association between serum vitamin A levels and the clinical outcomes of sepsis has not been well assessed. The aim of this study was to assess the prevalence of vitamin A deficiency in critically ill children with sepsis and its association with clinical outcomes. Methods Critically ill children with sepsis admitted to the pediatric intensive care unit were engaged in this prospective study. Sex- and age-matched approximate-health children from the Department of Pediatric Surgery were enrolled as the control group. Blood samples were collected from all patients in the first 24 h of admission for the measurement of serum vitamin A status. We compared vitamin A status between the sepsis group and the control group. In addition, we compared the clinical characteristics of the two subgroups of septic patients with vitamin A deficiency and those without vitamin A deficiency. Univariate and multivariable methods were used to evaluate the association between vitamin A deficiency and septic shock. Results One hundred sixty septic children and 49 approximate-health children were enrolled in this study. Vitamin A deficiency was found in 94 (58.8%) subjects in the study group and 6 (12.2%) subjects in the control group ( P  < 0.001). In septic patients, 28-day mortality and hospital mortality in patients with vitamin A deficiency were not significantly higher than that in patients without vitamin A deficiency ( P  > 0.05). However, vitamin A levels were inversely associated with higher PRISM scores in septic children with VAD ( r  = − 0.260, P  = 0.012). Vitamin A deficiency was associated with septic shock with an unadjusted odds ratio (OR) of 3.297 (95% confidence interval (CI), 1.169 to 9.300; P  = 0.024). In a logistic model, vitamin A deficiency (OR, 4.630; 95% CI, 1.027–20.866; P  = 0.046), procalcitonin (OR, 1.029; 95% CI, 1.009–1.048; P  = 0.003), and the Pediatric Risk of Mortality scores (OR, 1.132; 95% CI, 1.009–1.228; P  = 0.003) were independently associated with septic shock. Conclusion The prevalence of vitamin A deficiency was high in children with sepsis. Vitamin A deficiency may be a marker of mortality in critically ill children with sepsis. Trial registration Clinicaltrials.gov , NCT03598127