Nutritional rickets and vitamin D deficiency—association with the outcomes of childhood very severe pneumonia: A prospective cohort study

BACKGROUND: The association of rickets and vitamin D deficiency (VDD) with pneumonia is well documented, but not with its outcomes. OBJECTIVES: To investigate whether rickets and VDD predict the outcomes in very severe pneumonia (VSP). DESIGN: A prospective cohort study conducted at Al-Sabeen hospital in Sana'a, Yemen. A total of 152 children aged 2-59 months with WHO-defined VSP were enrolled, managed, and followed for up to 30 days. Treatment outcome was either successful or failure (antibiotic modification for clinical worsening, death, relapse after 10-day antibiotics, or development of complications). Serum vitamin D (25OHD) was measured in 79 cases. A concentration of <or=30 nmol/L defines VDD. MAIN OUTCOME MEASURES: Association of rickets with treatment outcome; and VDD with the circulating neutrophils (PMNs), and oxygen saturation% (SpO(2)%), respectively. RESULTS: Treatment failure occurred in 24 (15.8%), all aged 2-12 months, and 21 (87.5%) were rachitic. Of the 79 subset, 29 had VDD of which 23 (79.3%) had rickets. Treatment failure was significantly higher in the rachitic compared to non-rachitic 20.6% (21/102) vs. 6% (3/50); OR 1.38 (95% CI 1.13-1.69), P = 0.031. In multivariate regression, rickets significantly predict a reduced successful treatment compared with non-rachitic 79.4% (81/102) vs. 94% (47/50); Adjusted OR 0.41 (95% CI 0.20-0.85); P = 0.02. VDD was strongly associated with reduced PMNs% Mean (SD) 37 (17) vs. 47 (17); Adjusted OR 0.71 (95% CI 0.53-0.95), P = 0.02, and reduced SpO(2)% Mean (SD) 85.9 (7.9) vs. 89.8 (7.1); OR 0.96 (95% CI 0.93-0.99), P = 0.021. CONCLUSIONS: In VSP, rickets was significantly associated with treatment outcome and VDD significantly predict both reduced circulating PMNs, and Day-5 hypoxemia (SpO(2)%, <88%).