الفهرس 
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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.