Vitamin D and morbidity in children with multisystem inflammatory syndrome related to Covid-19.

This study showed a potential association between severe vitamin D deficiency and severe covid-19 in children with multisystem inflammatory syndrome.

• Ten patients had severe vitamin D deficiency with a mean level of 7.2 ng/ml.  
• Ninety percent of patients with severe vitamin D deficiency had severe disease (P < 0.001). Patients with severe vitamin D deficiency had an increased risk of cardiac involvement (P < 0.001). 
• There were 13 (41.9%) patients who had cardiac involvement. It consisted of 12 patients with ventricular dysfunction, 4 patients with coronary artery involvement, 5 patients had pericardial effusion and 9 patients had an abnormal electrocardiogram.  
• The group with cardiac involvement had a mean (SD) 25-OH vitamin D level of 9.6 (4.3) ng/ml vs. 23.7 (10.6) ng/ml for the rest of the cohort (P < 0.01).  
• The group with severe vitamin D deficiency had an increased risk of cardiac involvement (OR: 38.3; 95% CI; 3.7–395.3; P < 0.01).  
• Those with severe vitamin D deficiency had reduced left ventricular ejection and shortening fraction compared to the group with non-severe vitamin D deficiency (P < 0.001). 

31 hospitalized patients aged between 1 and 13 years, 45% male, 58% African American, with diagnosis of Multisystem inflammatory syndrome (MIS-C).

• The study is a single center retrospective study with a relatively small number of patients.
• Data collection and statistical analysis were limited to data already recorded in the medical records.
• There was no control for confounding. 
• This study only assessed a small number of children under the age of 13, limiting the generalizability. 

“We describe a potential association between severe vitamin D deficiency and severe disease in children presenting with MIS-C due to Covid-19. Severe vitamin D deficiency predisposes patients for cardiovascular involvement due to altered cellular homeostasis mediated by widespread VDRs in the cardiovascular system. Furthermore, the immune modulatory activity of vitamin D may play a critical role in the host immune response to Covid-19 infection. Future prospective studies at the basic science and clinical level should be pursued to better delineate this association.” 

• This is a retrospective and single center study. 
• The study included hospitalized patients less than 18 years of age with diagnosis of Multisystem inflammatory syndrome (MIS-C) between March and July 2020. Severe vitamin D deficiency was defined as 25-OH vitamin D level < 10 ng/ml within 48 h of admission. The composite outcome severe disease included patients requiring inotropes, mechanical ventilation, and extracorporeal membrane oxygenation.

Torpoco-Rivera D, Misra A, Sanil Y, Sabzghabaei N, Safa R, Garcia RU. Vitamin D and morbidity in children with multisystem inflammatory syndrome related to Covid-19. Prog Pediatr Cardiol. 2022 Mar 1:101507. doi: 10.1016/j.ppedcard.2022.101507. Epub ahead of print. PMID: 35250251; PMCID: PMC8885084.