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 ≤30 nmol/L defines VDD. Main Outcome Measures Association of rickets with treatment outcome; and VDD with the circulating neutrophils (PMNs), and oxygen saturation% (SpO2%), 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 SpO2% [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 (SpO2%,