The association of serum vitamin D levels and severity of pneumonia in children

Abstract

Pneumonia is one of the most common diseases in the world, and it is the main factor leading to hospitalization. It is also the most common cause of sepsis and septic shock in more than 50% of cases. Vitamin D has an antimicrobial function by regulating the production of antimicrobial peptides that play an essential role in the immune response. In addition, a decrease in the level of these peptides has been observed in people with vitamin D deficiency, which has led to the observation of adverse outcomes in patients with pneumonia. This study aims to determine the relationship between serum vitamin D levels and pneumonia severity in children. Materials and Methods: In this cross-sectional study, children aged 2 months to 15 years with suspected symptoms of pneumonia referred to Zahra Mardani Children's Educational, Research, and Treatment Center in Azari, Tabriz, were included in the study. 100 hospitalized patients, after confirming the disease with chest x-rays and obtaining informed consent from the parents, were included in the study and were classified according to the severity of the disease into two levels: mild, moderate, and severe. The laboratory findings of the patients included WBC and lymphocyte counts, CRP, ESR, urea, creatinine, and vitamin D. The outcome of the patients was also considered as recovered or alive and dead. Finally, the serum vitamin D (25-OH-D) and other laboratory factors were statistically compared among the groups. Results: The average age of children with pneumonia was 5.4 ± 2.2 years, and 64% were male. The pneumonia was mild to moderate in 74% of patients and severe in 26%. The most common underlying disease was neurological disorders, which had a significantly higher frequency in patients with severe pneumonia (15.4% vs. 9.5%; p=0.022). SpO2 values in patients with severe pneumonia were significantly lower than in patients with mild to moderate pneumonia (83.3±13.1 vs. 90.5±4.6; p=0.011). The serum level of vitamin D in patients with mild to moderate pneumonia was 25.2 ± 10.1 nmol/L; in patients with severe pneumonia, it was 21.8 ± 7.6 nmol/L; No statistically significant difference was observed between the two groups (p=0.079). The frequency of vitamin D deficiency in patients with mild to moderate pneumonia and patients with severe pneumonia was 78.4% and 92.3%, respectively. No statistically significant difference was observed between the two groups (p=0.093). The duration of hospitalization in patients with severe pneumonia was longer (13.8 ± 7.8 days versus 9.1 ± 7.6 days; p=0.010). The frequency of requiring hospitalization in PICU was significantly higher in patients with severe pneumonia (61.6% vs. 10.8%; p=0.001).