Peer-reviewed article
Status of non-thiamine B-vitamins in children with septic shock from a lower middle-income country: a case-control study.
Ajay Kumar, Arun Kumar Baranwal, Savita Verma Attri, Praveen Kumar-M, Arushi Gahlot Saini et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compared B-vitamin levels in 79 children with septic shock to 86 healthy controls from a lower-middle-income country. Children with septic shock had significantly lower levels of five B-vitamins (riboflavin, niacin, pyridoxine, folate, and cobalamin) compared to healthy siblings and external controls. The findings suggest that B-vitamin deficiencies may be pre-existing in the community and become worse during septic shock, pointing to a potential need for B-vitamin supplementation in treating this condition.
Key points
- All five B-vitamins measured were significantly lower in septic shock patients compared to sibling controls (all p < 0.001)
- Patients and their siblings were more stunted than external controls, indicating chronic nutritional challenges in the household
- Among non-survivors, riboflavin and pyridoxine levels were lower than in survivors
- Sibling controls had lower B-vitamin levels than external controls from an immunization clinic, suggesting family-level nutritional deficiencies
- The study suggests B-vitamin deficiencies are likely pre-existing in the community and worsen during septic shock
Limitations
The study cannot establish causation or demonstrate that B-vitamin deficiencies directly affect septic shock outcomes, as it is observational. The small number of non-survivors (n not specified) and lack of information on the specific LMIC country limits generalizability of findings.
Abstract
The role of B-vitamins in septic shock is gaining attention, especially among patients with deficiencies. However, evidence beyond thiamine remains limited. This study aimed to evaluate the status of riboflavin, niacin, pyridoxine, folate, and cobalamin in children with septic shock in a low- and middle-income country (LMIC) setting, and to explore their potential association with patient outcomes. We enrolled 79 consecutive patients (aged 6 months-12 years) with fluid-refractory septic shock from July 2018 to December 2019. We also included 22 sibling controls and 64 external controls from an immunization clinic for comparison. Children with chronic illnesses or those receiving vitamin supplementation were excluded. Plasma levels of riboflavin, niacin, pyridoxine, folate, and cobalamin were measured at enrolment, and patient survival was assessed as the primary outcome. Patients and their siblings were more stunted than external controls, both in prevalence (P = .014) and severity (P = .012). Plasma levels of all five B-vitamins were significantly lower in patients compared to sibling controls (all P values less than .001). Sibling controls had lower levels of riboflavin (P < .001), niacin (P < .001), pyridoxine (P = .072), folate (P = .070), and cobalamin (P < .001) than external controls. Among the patients, non-survivors had lower levels of riboflavin (P = .20) and pyridoxine (P = .04), while folate levels were surprisingly higher (P = .037). With shared nutrition in families, findings suggest exacerbation of the likely pre-existing B-vitamin deficiencies during septic shock in children from LMICs. This highlights the need to evaluate the potential adjunctive therapeutic role of B-vitamins in paediatric septic shock in LMICs.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Measurement of plasma B-vitamin levels (riboflavin, niacin, pyridoxine, folate, cobalamin) in children with septic shock to evaluate deficiency status
- Population
- 79 children aged 6 months to 12 years with fluid-refractory septic shock from an LMIC, compared to 22 sibling controls and 64 external controls from an immunization clinic
Key finding
All five B-vitamins were significantly lower in septic shock patients compared to sibling controls (all p < 0.001)