Correlation Between Serum 25（OH）D₃ Level And Sepsis In Children

PurposeBy measuring the serum 25（OH）D₃levels in children with sepsis,the serum levels of25（OH）D₃and their correlation with the criticality of sepsis and clinical prognosis were analyzed to provide a theoretical basis for assessing the prognosis and guiding the treatment of children with sepsis.Research Subjects and MethodsFrom October 2021 to January 2023,children with sepsis in the Affiliated Hospital of Qingdao University were studied at.General data such as age,sex,height,weight and body mass of children with sepsis within 24 hours of admission were recorded,and the pediatric critical illness score（PCIS）was applied to evaluate the condition of children with sepsis.The degree of critical illness was evaluated by applying the Pediatric Critical Illness Score（PCIS）,and clinical data such as length of hospitalization,mechanical ventilation during hospitalization,impaired organ function,and discharge outcome were recorded.Venous blood was collected within 24 hours of admission（T₀）from septicemic children and venous blood from children with health check-ups in our hospital during the same period,and venous blood was collected again 1 week after hospitalization（T₁）from septicemic children,and the blood specimens were rested,centrifuged,separated from serum,and frozen at-80℃for examination.The 25（OH）D₃level was measured by enzyme-linked immunosorbent assay（ELISA）.The children with sepsis were divided into critical and non-critical groups according to the Pediatric Critical Case Score（PCIS）at T₀,and the children with healthy physical examination at the same period were healthy controls.The serum 25（OH）D₃levels at T₀were compared among the critical,non-critical and healthy control groups;the changes in serum 25（OH）D₃levels at 1 week of hospitalization were compared between the critical and non-critical groups;the children with sepsis were divided into vitamin D sufficient,vitamin D insufficient and vitamin D deficient groups according to the serum 25（OH）D₃levels at T₀,and the duration of hospitalization,mechanical ventilation during hospitalization,organ function impairment and discharge outcome were compared among the three groups.The duration of hospitalization,mechanical ventilation during hospitalization,impaired organ function,and discharge outcome were compared.The data were statistically processed using SPSS26.0 statistical software.Results1.general data:87 children with sepsis were included in this study,including 15 cases in the critical group（15/87,17.24%）and 72 cases in the non-critical group（72/87,82.76%）;80 cases in the healthy control group.There was no statistically significant difference in gender,age,weight,body mass,and season of admission between the three groups of critical group,non-critical group,and healthy control group（P>0.05）.2.Analysis of the criticality of children with sepsis and serum 25（OH）D₃levels at T₀The level of 25（OH）D₃was 18.99±6.84 ng/m L in the children with sepsis,and 13.79±3.89 ng/m L in the critical group and 20.39±6.48 ng/m L in the non-critical group.The level of serum 25（OH）D₃in healthy control group was 32.16±10.18 ng/m L.The level of 25（OH）D₃in sepsis group was lower than that in healthy control group,and the difference was statistically significant（P<0.05）.The level of serum 25（OH）D₃in critical group was lower than that in non-critical group and healthy control group,and the difference was statistically significant（P<0.05）.There were statistically significant differences in multiple comparisons among the critical group,non-critical group and healthy control group（P<0.05）.The 25（OH）D₃deficiency and insufficiency rates were 57.47%and 14.94%in the children with sepsis,and the serum 25（OH）D₃deficiency and insufficiency rates were86.67%and 6.67%in the critical group,and 51.39%and 16.67%in the non-critical group.The deficiency and insufficiency rates of serum 25（OH）D₃in healthy control group were8.75%and 33.75%.The 25（OH）D₃deficiency rate in sepsis group was higher than that in healthy control group,and the difference was statistically significant（P<0.05）.The serum25（OH）D₃deficiency rate in critical group was higher than that in non-critical group and healthy control group,and the difference was statistically significant（P<0.05）.There were statistically significant differences in multiple comparisons among the critical group,non-critical group and healthy control group（P<0.05）.3.Analysis of changes in serum 25（OH）D₃levels in children with sepsis 1 week after admission to hospitalThe levels Serum 25（OH）D₃were 18.99±6.84 ng/m L at T₀and 16.65±4.43 ng/m L at T₁in children with sepsis,and 25（OH）D₃levels were lower at T₁compared to T₀,with no statistically significant difference（P>0.05）.In the critical group,the serum 25（OH）D₃level was 13.79±3.89 ng/m L at T₀and 6.00±2.40 ng/m L at T₁,and the 25（OH）D₃level at T₁was lower than that at T₀,with statistical significance（P<0.05）.In the non-critical group,the serum 25（OH）D₃level was 20.39±6.48 ng/m L at T₀and 16.29±6.53 ng/m L at T₁,and the level of 25（OH）D₃at T₁was lower than that at T₀,with no statistical significance（P>0.05）.4.Analysis of serum 25（OH）D₃level and disease condition and prognosis in children with sepsisAmong 87 children with sepsis,50 cases（50/87,57.47%）were vitamin D deficiency,13 cases（13/87,14.94%）were vitamin D insufficiency,and 24 cases（24/87,27.59%）were vitamin D sufficient.In the vitamin D deficient group,the admission PICS score was 82±19points,the mean length of stay was 13.12±3.28 days,multi-organ dysfunction occurred in16 cases（16/50,32.00%）,7 cases（7/50,14.00%）were ventilated with mechanical ventilation assisted breathing,and 5 cases（5/50,10.00%）died;in the vitamin D insufficient group,the admission PICS score was 90±6 points,mean length of stay 11.00±2.24 days,1cases（1/13,7.69%）with multiorgan dysfunction,1 case（1/13,7.69%）with mechanical ventilation assisted breathing,and 1 case（1/13,7.69%）died;the vitamin D adequate group had an admission PICS score of 92±4 points,mean length of stay 10.67±2.44 days,2cases（2/24,8.33%）had multi-organ dysfunction,1 case（1/24,4.17%）was ventilated with mechanical ventilation to assist breathing,and 1 case（1/24,4.17%）died.The number of days of hospitalization and the rate of multi-organ dysfunction were higher in the vitamin D deficient group than in the vitamin D insufficient and sufficient groups,and the admission PCIS score was lower than in the vitamin D insufficient and sufficient groups,and the difference was statistically significant（P<0.05）.However,the differences in mean age,sex ratio,body mass,mechanical ventilation rate,and mortality rate among the three groups were not statistically significant（P>0.05）.Conclusion1.Vitamin D deficiency is common in children with sepsis.2.Vitamin D deficiency is associated with criticality of disease in children with sepsis.3.Vitamin D levels continue to decline in children with sepsis,and the decline is more pronounced in those in critical condition.4.Vitamin D deficiency was associated with prolonged hospitalization,increased disease severity,and high risk of multi-organ dysfunction in children with sepsis,but not with the use of mechanical ventilation or mortality,suggesting that children with vitamin D-deficient sepsis are critically ill,prone to combined organ dysfunction,and have prolonged hospitalization,but not increased mortality.