Status of non-thiamine B-vitamins in children with septic shock from a lower middle-income country: a case-control study

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.