The association between vitamin D levels and the clinical severity and inflammation markers in pediatric COVID-19 patients: single-center experience from a pandemic hospital
Elvan Bayramoğlu, Gülşen Akkoç, Ayşe Ağbaş, Özlem Akgün, Kamer Yurdakul, Hatice Nilgün Selçuk Duru, Murat Elevli
European Journal of Pediatrics, doi:10.1007/s00431-021-04030-1
Vitamin D has an immunomodulating property that regulates the inflammatory response. In this study, the aim was to evaluate the relationship between vitamin D levels and clinical severity and inflammation markers in children and adolescents with COVID-19. The clinical and laboratory records of 103 pediatric cases with COVID-19, whose vitamin D levels had been measured, were retrospectively reviewed. The cases were divided into groups according to their clinical severity (asymptomatic, mild, and moderate-to-severe) and vitamin D levels. The moderate-to-severe clinical group had significantly higher inflammation markers (CRP, procalcitonin, fibrinogen, D- dimer) and a lower lymphocyte count compared to both the mild and asymptomatic groups. The 25 OH vitamin D levels were also significantly lower (p < 0.001), and the ratio of vitamin D deficiency was 70.6% in the moderate-to-severe group. The vitamin D-deficient group had a significantly higher age and fibrinogen levels while also having a lower lymphocyte count compared to the insufficient and normal groups. The 25 OH vitamin D level was correlated positively with the lymphocyte count (r = 0.375, p = <0.001), and negatively with age (r = −0.496, p = <0.001), CRP (r = −0.309, p = 0.002) and fibrinogen levels (r = −0.381, p = <0.001). In a logistic regression analysis, vitamin D deficiency, D-dimer, and fibrinogen levels on admission were independent predictors of severe clinical course. Conclusion: This study revealed an association between vitamin D deficiency and clinical severity, in addition to inflammation markers in pediatric COVID-19 cases. Prophylactic vitamin D supplementation may be considered, especially in the adolescent age group.
Authors' contributions EB, GA, and AA design the study. EB, GA, KD, and OA data acquisition. EB and AA performed the statistical analysis. EB, AA, and GA wrote the manuscript. EB, GA, AA, HNSD, and ME reviewed the manuscript.
Conflict of interest The authors declare no competing interests. Ethics approval This study was approved by the local ethical committee (Haseki Training and Research Hospital, 2020-56, 14.05.2020).
Consent to participate None (retrospective study) Consent for publication All authors consent to the publication of the manuscript in European Journal of Pediatrics, should the article be accepted by the Editor-in-chief upon completion of the refereeing process.
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