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J Pediatr Infect Dis 2022; 17(04): 194-199
DOI: 10.1055/s-0042-1749372
Original Article

The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children

Ahmet Kan 
1   Department of Pediatric Allergy and Immunology, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Mehmet Türe 
2   Department of Pediatric Cardiology, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Alper Akın 
2   Department of Pediatric Cardiology, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Kamil Yılmaz 
3   Department of Pediatrics, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Mehmet Sürücü 
3   Department of Pediatrics, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Edip Ünal 
4   Department of Pediatric Endocrinology, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Velat Şen
5   Department of Pediatric Pulmonology, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
,
Veysiye Hülya Üzel 
6   Department of Pediatric Hematology, Dicle University Faculty of Medicine, Dicle University, Diyarbakır, Turkey
› Author Affiliations Funding None.
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Abstract

Objective Multiple factors being overweight, asthmatic, or being of Asian or black ethnic origins have been reported vis-à-vis the “multisystem inflammatory syndrome in children” (MIS-C). There is an association between these conditions and vitamin D deficiency, which explains why MIS-C is more common in these patients. In the present study, we attempted to retrospective evaluate the 25-hydroxy vitamin D levels of patients with MIS-C, its association with acute phase reactants, its treatment, and clinical status.

Methods Patients aged between 1.5 months to 18 years with MIS-C were included in the study. All of the laboratory parameters, treatment, and response to the treatment were evaluated retrospectively. Two groups were formed. Patients had 25‐hydroxycholecalciferol D vitamin < 20 ng/mL in group 1 and ≥ 20 ng/mL in group 2.

Results A total of 52 patients were included in the study. There was no statistical difference between groups in terms of acceptance of the intensive care unit treatment (p = 0.29) and response to the first-line treatment (p = 0.56). A lower median lymphocyte count (p = 0.01) and a higher median C-reactive protein (p = 0.04) and procalcitonin (p = 0.01) with N-terminal pro-B-type natriuretic peptide (p = 0.025) values were found in group 1.

Conclusion Vitamin D deficiency was associated with an increased inflammatory response in children with MIS-C. More studies are required to determine the potential impact of vitamin D deficiency on the clinical outcome of MIS-C.

Keywords

multisystem inflammatory syndrome - vitamin D - inflammation parameters

Authors' Contributions

A.K., K.Y., A.A., and E.Ü. designed the study, A.K. and K.Y. wrote this manuscript, V.Ş. and K.Y. gave conceptual advice, M.T., V.H.Ü., and M.S. collected and analyzed the data. All authors read and approved the final manuscript.




Publication History

Received: 06 February 2022

Accepted: 23 April 2022

Article published online:
11 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Whittaker E, Bamford A, Kenny J. et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324 (03) 259-269
    CrossrefPubMedGoogle Scholar
  • 2 WHO. Multisystem inflammatory syndrome in children and adolescents with COVID19: scientific brief. World Health Organization. Geneva: 2020 . Accessed August 26, 2020 at: https://apps.who.int/iris/handle/10665/332095
    PubMedGoogle Scholar
  • 3 Licciardi F, Baldini L, Denina M. et al. Peculiar immunophenotypic signature in MIS-C-affected children. Pediatr Allergy Immunol 2021; 32 (04) 801-804
    CrossrefPubMedGoogle Scholar
  • 4 Tsabouri S, Makis A, Kosmeri C, Siomou E. Risk factors for severity in children with coronavirus disease 2019: a comprehensive literature review. Pediatr Clin North Am 2021; 68 (01) 321-338
    CrossrefPubMedGoogle Scholar
  • 5 Grant WB, Lahore H, McDonnell SL. et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients 2020; 12 (04) 988
    CrossrefPubMedGoogle Scholar
  • 6 Feketea G, Vlacha V, Bocsan IC, Vassilopoulou E, Stanciu LA, Zdrenghea M. Vitamin D in corona virus disease 2019 (COVID-19) related multisystem inflammatory syndrome in children (MIS-C). Front Immunol 2021; 12: 648546
    CrossrefPubMedGoogle Scholar
  • 7 Yılmaz K, Şen V. Is vitamin D deficiency a risk factor for COVID-19 in children?. Pediatr Pulmonol 2020; 55 (12) 3595-3601
    CrossrefPubMedGoogle Scholar
  • 8 Stagi S, Rigante D, Lepri G, Matucci Cerinic M, Falcini F. Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities?. Clin Rheumatol 2016; 35 (07) 1865-1872
    CrossrefPubMedGoogle Scholar
  • 9 Hara T, Nakashima Y, Sakai Y, Nishio H, Motomura Y, Yamasaki S. Kawasaki disease: a matter of innate immunity. Clin Exp Immunol 2016; 186 (02) 134-143
    CrossrefPubMedGoogle Scholar
  • 10 Lee PY, Day-Lewis M, Henderson LA. et al. Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflammatory syndrome in children. J Clin Invest 2020; 130 (11) 5942-5950
    CrossrefPubMedGoogle Scholar
  • 11 Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol 2010; 10 (04) 482-496
    CrossrefPubMedGoogle Scholar
  • 12 Zhang Y, Leung DY, Richers BN. et al. Vitamin D inhibits monocyte/macrophage proinflammatory cytokine production by targeting MAPK phosphatase-1. J Immunol 2012; 188 (05) 2127-2135
    CrossrefPubMedGoogle Scholar
  • 13 Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients 2015; 7 (06) 4240-4270
    CrossrefPubMedGoogle Scholar
  • 14 Meyer K, Volkmann A, Hufnagel M. et al. Breastfeeding and vitamin D supplementation reduce the risk of Kawasaki disease in a German population-based case-control study. BMC Pediatr 2019; 19 (01) 66
    CrossrefPubMedGoogle Scholar
  • 15 Jun JS, Jung YK, Lee DW. Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease. Korean J Pediatr 2017; 60 (07) 216-220
    CrossrefPubMedGoogle Scholar
  • 16 Fabi M, Filice E, Biagi C. et al. Multisystem inflammatory syndrome following SARS-CoV-2 infection in children: one year after the onset of the pandemic in a high-incidence area. Viruses 2021; 13 (10) 2022
    CrossrefPubMedGoogle Scholar
  • 17 Harwood R, Allin B, Jones CE. et al; PIMS-TS National Consensus Management Study Group. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Health 2021; 5 (02) 133-141
    CrossrefPubMedGoogle Scholar
  • 18 Yeşiltepe-Mutlu G, Aksu ED, Bereket A, Hatun Ş. Vitamin D status across age groups in Turkey: results of 108742 samples from a private laboratory. J Clin Res Pediatr Endocrinol 2020; 12 (03) 248-255
    CrossrefPubMedGoogle Scholar
  • 19 Jain A, Chaurasia R, Sengar NS, Singh M, Mahor S, Narain S. Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Sci Rep 2020; 10 (01) 20191
    CrossrefPubMedGoogle Scholar
  • 20 Darren A, Osman M, Masilamani K. et al. Vitamin D status of children with paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS). Br J Nutr 2022; 127 (06) 896-903
    CrossrefPubMedGoogle Scholar
  • 21 Martinez OM, Bridges ND, Goldmuntz E, Pascual V. The immune roadmap for understanding multi-system inflammatory syndrome in children: opportunities and challenges. Nat Med 2020; 26 (12) 1819-1824
    CrossrefPubMedGoogle Scholar
  • 22 Henderson LA, Canna SW, Friedman KG. et al. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 2. Arthritis Rheumatol 2021; 73 (04) e13-e29
    CrossrefPubMedGoogle Scholar
  • 23 Nijman RG, De Guchtenaere A, Koletzko B. et al. Pediatric inflammatory multisystem syndrome: statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics. Front Pediatr 2020; 8: 490
    CrossrefPubMedGoogle Scholar
  • 24 Abrams JY, Oster ME, Godfred-Cato SE. et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health 2021; 5 (05) 323-331
    CrossrefPubMedGoogle Scholar
  • 25 Daneshkhah A, Agrawal V, Eshein A, Subramanian H, Roy HK, Backman V. Evidence for possible association of vitamin D status with cytokine storm and unregulated inflammation in COVID-19 patients. Aging Clin Exp Res 2020; 32 (10) 2141-2158
    CrossrefPubMedGoogle Scholar
  • 26 Zhou Y-F, Luo B-A, Qin L-L. The association between vitamin D deficiency and community-acquired pneumonia: a meta-analysis of observational studies. Medicine (Baltimore) 2019; 98 (38) e17252
    CrossrefPubMedGoogle Scholar
  • 27 Dalvi SM, Ramraje NN, Patil VW, Hegde R, Yeram N. Study of IL-6 and vitamin D3 in patients of pulmonary tuberculosis. Indian J Tuberc 2019; 66 (03) 337-345
    CrossrefPubMedGoogle Scholar
  • 28 Lu D, Zhang J, Ma C. et al. Link between community-acquired pneumonia and vitamin D levels in older patients. Z Gerontol Geriatr 2018; 51 (04) 435-439
    CrossrefPubMedGoogle Scholar
  • 29 Panfili FM, Roversi M, D'Argenio P, Rossi P, Cappa M, Fintini D. Possible role of vitamin D in Covid-19 infection in pediatric population. J Endocrinol Invest 2021; 44 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 30 Absoud M, Cummins C, Lim MJ, Wassmer E, Shaw N. Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS One 2011; 6 (07) e22179
    CrossrefPubMedGoogle Scholar
  • 31 Cashman KD, Dowling KG, Škrabáková Z. et al. Vitamin D deficiency in Europe: pandemic?. Am J Clin Nutr 2016; 103 (04) 1033-1044
    CrossrefPubMedGoogle Scholar