الفهرس | Only 14 pages are availabe for public view |
Abstract Vitamin A is an immunomodulatory, and its deficiency may cause an imbalance between pro- and anti-inflammatory factors and impaired immune function, which are found in sepsis. There is a biological rationale that VAD may be a contributing factor related to poor clinical outcomes in patients with sepsis. Importantly, VAD is highly prevalent in children, especially in preschool children. However, there is a paucity of data regarding the correlation between VAD and sepsis. The aim of this study was to evaluate serum vitamin A level in critically ill children with sepsis and its potential association with illness severity and prediction of prognosis. This was a prospective observational study was conducted on two groups of patients: Patient group: this was consisted of a cohort of critically ill children admitted into the PICU aged of 1 month to 16 years with a diagnosis of sepsis. Control group: this was consisted of apparently healthy children with no history of prior hospital admission for more than 3 days. All Patients were subjected to full history taking, clinical examination, calculation of PIM2, and SOFA score for all patients upon admission. Complete blood count, c-reactive protein, hepatic and renal function tests, venous blood gases, blood culture Serum vitamin A level was measured to patients within 24 hours of PICU admission and to all controls. Summary 109 All patients were closely monitored to determine the relation of vitamin A to clinical outcome, including mortality; length of PICU stay; mechanical ventilation duration; and mortality predictive scores. Our results revealed that: There were no significant differences between the patients and control groups regarding age and sex, while there was significant decrease in weight of patients group compared with the control group There was no significant difference between the patient and control groups regarding vitamin A level. There was no significant difference between the patients and control groups regarding prevalence of vitamin A deficiency. The frequency of low vitamin A level was significantly higher among non-survivors compared with survivors . Vitamin A level was significantly lower among patients with severe sepsis, MODS, ARDS, mechanical ventilation, and nosocomial infections. Patients with severe sepsis had significantly higher frequency of mechanical ventilation, vasoactive medication use, and mortality. They also had significantly greater vasoactive infusion days; vasopressor-inotrope score on day1 and 2; PIM2 score; and pSOFA score. Patients with severe sepsis also had significantly lower ventilator-free days. Patients with severe sepsis had significantly higher serum creatinine level and significantly lower platelet count. Summary 110 Non-survivors had significantly higher frequency of severe sepsis, ARDS, mechanical ventilation, nosocomial infections, vasoactive medication use, and MODS on day1 and 3. Nonsurvivors also had significantly higher PIM2 score, pSOFA score, vasoactive infusion days, and vasopressor-inotrope score on day1 and 2 but had significantly lower ventilator-free days. Non-survivors had significantly lower platelet count and vitamin A level. No significant difference was found in other variables. pSOFA and nosocomial infections had positive association with mortality while vitamin A level had negative association with mortality . Through multivariate logistic regression analysis, pSOFA, vitamin A level, and nosocomial infection remained independent predictors of mortality. pSOFA score was the best predictor of mortality (AUC= 0.81) followed by vitamin A level (AUC=0.77). At a cutoff level of ≤ 29.5 ug/ml, vitamin A had a sensitivity of 83.3% and a specificity of 0.71.7%. There was significant weak negative correlations between vitamin A level and height, pSOFA, and PIM2. |