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Vitamin A and Zinc Deficiencies in Developing of Childhood Sepsis: A Case-control Study in Tehran, Iran

Samileh Noorbakhsh, Azizolah Yusefi, Shirin Sayahfar, Sarvenaz Ashouri

Objective: Sepsis is one of the most important and serious infection with high mortality in childhood. The aim of this study was to determine the serum level of vitamin A and zinc in children with sepsis compared to control group.

Methods: This case-control study was performed on 40 septic children and 25 controls admitted to Rasoul-e-Akram and Ali Asghar hospitals affiliated by Iran University of Medical Sciences in Tehran from July 2015 to September 2016. The case group included children less than 5 years old with septicemia and the control group consisted 25 children without infection (healthy children undergone for elective surgery). 5 ml of blood was taken from both groups. The amount of vitamin A was determined by High-Performance Liquid Chromatography (HPLC) method and zinc levels determined by calorimetric method. The student’s t test, chi square and other tests by Statistical Package for the Social Sciences (SPSS) software, version 13.5 were used. Probability (P) values lower than 0.05 were considered significant in this trial.

Results: Seven of 40 patients died due to severity of disease and septic shock. 33 cases (mean age of 58.4 years), 60.6% male, 39.4% female and control group were evaluated. Sex (P=0.8) and mean age (P=1.000) were not significantly different between two groups. 57.6% of patients with sepsis had zinc deficiency and 42.4% had vitamin A deficiency, but none controls had deficiencies. Vitamin A cut off level 0.25, had 75% sensitivity and 48% specifity. Zinc serum cutoff level 0.605 had 75% sensitivity and 40% specifity to differentiate the septic cases from control group.

Conclusion: Based on the current study, a significant percentage of young septic children (<5 years old) were deficient for zinc (57.6%) and vitamin A (42.4%) but none of controls. Although low levels of vitamin A in our children (based on previous studies) do not play a significant role in the development of limited bacterial infections (respiratory, gastrointestinal, urinary), it is observed that the deficiency of both zinc and vitamin A in young studied children predispose them to a severe form of bacterial infections and increases the risk of sepsis and mortality rate. So adding vitamin A and zinc to children's diets will reduce sepsis risk.