Can Serum 25-Hydroxy Vitamin D Levels Predict the Severity of Multisystem Inflammatory Syndrome in Children and COVID-19?
Yıldız Ekemen Keleş1, Dilek Yılmaz2, Selin Taşar1, Gülnihan Üstündağ1, Aslıhan Şahin1, Ayşegül Elvan Tuz1, Aslıhan Arslan Maden1, Ahu Kara Aksay1, Ayfer Çolak3, Eda Karadağ Öncel11University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, İzmir, Turkey2İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
3University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Medical Biochemistry, İzmir, Turkey
INTRODUCTION: To determine the clinical significance of serum 25-hydroxy (OH) vitamin D levels in pediatric patients with multisystem inflammatory syndrome in children (MIS-C) and compare the vitamin D levels of these patients with those patients with Coronavirus disease-2019 (COVID-19) and healthy controls.
METHODS: This study was designed for pediatric patients aged 1 month to 18 years and conducted between July 14 and December 25, 2021. Fifty-one patients with MIS-C, 57 who were hospitalized with COVID-19, and 60 controls were enrolled in the study. Vitamin D insufficiency was defined as a serum 25 (OH) vitamin D level of less than 20 ng/mL. Severe MIS-C was classified as necessitating intensive care due to cardiovascular instability, the necessity for non-invasive or invasive mechanical ventilation, and/or a diminishing Glasgow coma scale. World Health Organization definition criteria were used to describe the clinical stages of COVID-19 in children and patients were divided into four groups according to the clinical severity of COVID-19: asymptomatic, mild, moderate, and severe/critical.
RESULTS: The median serum 25 (OH) vitamin D was 14.6 ng/mL in patients with MIS-C, 16 ng/mL in patients with COVID-19, and 21.1 ng/mL in the control group (p<0.001). Vitamin D insufficiency was present in 74.5% (n=38) of patients with MIS-C, 66.7% (n=38) of patients with COVID-19, and 41.7% (n=25) of the controls (p=0.001). The percentage of four or more affected organ systems was 39.2% in patients with MIS-C. The correlation between the number of affected organ systems and serum 25 (OH) vitamin D levels was evaluated in patients with MIS-C and there was a moderate negative correlation (r=-0.310; p=0.027). A weak negative correlation was found between the severity of COVID-19 and serum 25 (OH) vitamin D (r=-0.320, p=0.015).
DISCUSSION AND CONCLUSION: Vitamin D levels were insufficient in both the MIS-C and COVID groups. Furthermore, vitamin D levels correlated with the number of affected organ systems in MIS-C and the severity of COVID-19.
Manuscript Language: English
