Paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) and Vitamin D deficiency

ABSTRACT

BackgroundCoronavirus disease 2019 (COVID-19), has caused mild illness in children, until the emergence of the novel hyperinflammatory condition PIMS-TS Paediatric Inflammatory Multisystem Syndrome Temporally associated with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PIMS-TS is thought to be a post- SARS-CoV-2 immune dysregulation with excessive inflammatory cytokine release.ObjectivesThere has been a long-standing interest in the role of 25 hydroxyvitamin D (25OHD) in cytokine-storm induced critical illnesses due to the premise of its anti-inflammatory actions including regulation of cytokine release. Vitamin D deficiency in critically ill individuals in intensive care has been linked to poor cardiovascular outcome and increased mortality.We report the vitamin D status of children with PIMS-TS admitted to a single tertiary paediatric hospital in the Midlands region of the United Kingdom (U.K).MethodsWe studied 25OHD levels in children admitted to a tertiary paediatric hospital in the U.K., fulfilling the case definition of PIMS-TS detailed by the Royal College of Paediatrics and Child Health. Children were managed either on paediatric intensive care unit (PICU group) or on the wards (non-PICU group). 25OHD concentrations were measured by quantitative liquid chromatography tandem mass spectrometry. Statistical analysis used a two-sample t-test, assuming unequal variances.ResultsFifty children [median (range) age 8.8 (0.99 to 14.6) years, male = 24] met the case definition. The majority were of Black, Asian and Minority Ethnic (BAME) origin [78%, 39/50]. SARS-CoV-2 IgG antibodies were confirmed in 64% (32/50) and SARS-CoV-2 RNA detected by PCR in 6% (3/50) of the study population. Of those patients without serology or PCR data available, the majority had a confirmed Covid 19 positive contact.Eighty-two percent of the cohort were vitamin D deficient (<30nmol/L). The mean 25OHD concentration was significantly lower when compared to the population mean from the 2015/16 National Diet and Nutrition Survey, a cohort of healthy children with no medical conditions, aged 4–10 years [22 vs 54nmol/L (95% CI 15.9, 24.1);p<0.001]. Children from BAME backgrounds had reduced vitamin D levels compared to children from a white background [mean 25OHD concentration 17.7 vs 28.2;p=0.12]. The PICU group had lower mean 25OHD concentrations compared to the non-PICU group, although this was not statistically significant [16.9 vs 28 nmol/L;p=0.071].ConclusionsPIMS-TS has seen an over-representation of children from BAME background, who are also at greatest risk of vitamin D deficiency. Whilst any link between vitamin D deficiency and the severity of COVID-19 and related conditions, including PIMS-TS, requires further evidence, public health measures to improve vitamin D status of the U.K BAME population has been long overdue. Given the safety profile of vitamin D supplementation and the over-representation of BAME individuals with vitamin D deficiency and PIMS-TS, mandated year-round supplementation of all high-risk children should be the way forward.