1. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis
- Author
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Evangelos Evangelou, Margarita Cariolou, Ioanna Tzoulaki, Antonio J. Berlanga-Taylor, Meghan A Cupp, Medical Research Council (MRC), and Medical Research Council
- Subjects
medicine.medical_specialty ,paediatric ,Adolescent ,Epidemiology ,Critical Illness ,prevalence ,vitamin D ,respiratory tract infections ,Cochrane Library ,Intensive Care Units, Pediatric ,Sepsis ,sepsis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,systematic review ,Intensive Care Units, Neonatal ,030225 pediatrics ,Internal medicine ,Intensive care ,medicine ,Vitamin D and neurology ,Humans ,030212 general & internal medicine ,Child ,intensive care ,Respiratory tract infections ,business.industry ,Research ,Confounding ,Infant, Newborn ,Infant ,General Medicine ,Vitamin D Deficiency ,medicine.disease ,mortality ,3. Good health ,meta-analysis ,Child, Preschool ,Meta-analysis ,Observational study ,business - Abstract
ObjectivesTo estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and investigate its association with mortality in children with acute or critical conditions.DesignSystematic review and meta-analysis of observational studies.Data sourcesPubMed, OVID, Google Scholar and the Cochrane Library searched until 21 December 2018.Eligibility criteriaStudies of children hospitalised with acute or critical conditions who had blood 25(OH)D levels measured.Data extraction and synthesisWe obtained pooled prevalence estimates of 25(OH)D deficiency and ORs for mortality. We calculated 95% CI and prediction intervals and investigated heterogeneity and evidence of small-study effects.ResultsFifty-two studies were included. Of 7434 children, 3473 (47.0%) were 25(OH)D deficient (2=95.3%, p2=89.3%, p2=94.3%, p2=25.7%, p=0.153). Four (22.0%) of the 18 studies statistically adjusted for confounders. There were insufficient studies to meta-analyse sepsis and RTI-related mortality.ConclusionsOur results suggest that 25(OH)D deficiency in acute and critically ill children is high and associated with increased mortality. Small-study effects, reverse causation and other biases may have confounded results. Larger, carefully designed studies in homogeneous populations with confounder adjustment are needed to clarify the association between 25(OH)D levels with mortality and other outcomes.Prospero registration numberCRD42016050638.
- Published
- 2019