Comparison of 25-Hydroxyvitamin D Levels in Pediatric Hematologic Cancer with and without Suspected Sepsis

Erfina Lim, IGAA Putri Sri Rejeki, I Dewa Gede Ugrasena


Vitamin D is known to play an important role in fighting infections through innate and adaptive immune systems. Children with cancer have a higher risk of suffering sepsis and vitamin D deficiency. Some studies on vitamin D levels in pediatric cancer with sepsis have shown varied results and remain controversial. This study aimed to analyze 25-hydroxyvitamin D levels in pediatric hematologic cancer with and without suspected sepsis. The study was an observational analytical study with a cross-sectional design. Samples were collected during April–September 2019 from the Pediatrics Outpatient Clinic of the Dr. Soetomo Hospital, Surabaya. The samples were a group of pediatric hematologic cancer consisted of 32 subjects with suspected sepsis and 30 without sepsis. Each group was measured the 25-hydroxyvitamin D levels, then differences in levels of 25-hydroxyvitamin D between groups were assessed. Vitamin D levels were measured using ADVIA Centaur. Both groups had low 25-hydroxyvitamin D levels with a deficiency state of 96.9% and 80% in the suspected sepsis group and group without sepsis. There were differences in levels of 25-hydroxyvitamin D in pediatric cancer with and without suspected sepsis (p=0.045). Lower vitamin D levels were found in the cancer group with suspected sepsis. Low vitamin D levels reduce T-helper 2 activity, decrease cellular immunity, and decrease phagocytic macrophages, leading to an easier entry of pathogens and bacteremia. There were significant differences in 25-hydroxyvitamin D levels in pediatric hematologic cancer with and without suspected sepsis.


25-hydroxyvitamin D, pediatric cancer, sepsis

Full Text:



Saeed Amna Afzal, Usman Sadia, Fadoo Zehra, Abbas

Qalab. Outcome of sepsis in pediatric oncology

patients admitted in pediatric intensive care unit: A

developing contry perspective. Pediatric Hematology

Oncology Journal, 2019; 4 (2): 35-38.

Kementerian Kesehatan. Buletin jendela data dan

informasi kesehatan [Internet]. 2015; 1-11. Available

from: (accssed 23 Feb, 2019).

Kementerian Kesehatan. Hasil utama Riskesdas 2018

[Internet]. 2018. Available from: https://www.depkes. (accessed 23 Feb, 2019).

Widiaskara IM, Permono Bambang, IDG Ugrasena,

Ratwita Mia. Luaran pengobatan fase induksi pasien

leukemia limfoblastik akut pada anak di Rumah Sakit

Umum Dr. Soetomo Surabaya. Sari Pediatri, 2016;

(2): 128-34.

Elfaituri Muhammed Khaled, Morsy Sara, Tawfik

Gehad Mohamed, Abdelaal Abdelaziz, El-Qushayri

Amr Ehab, et al. Incidence of Infection-related

mortality in cancer patients: Trend and survival

analysis. Journal of Clinical Oncology, 2019; 37: 15.

Kar Aroop, Hijiya Nobuko. Diagnosis and initial

management of pediatric acute leukemia in the

Emergency Department setting. Clinical Pediatric

Emergency Medicine, 2018; 19(2): 135-144.

Sheikhpour E, Sadri Z, Heydari S, Ghanizadeh F.

Vitamin D deficiency and its relation with cancer in

children vitamin D and its metabolites. Iran J Ped

Hematol Oncol, 2018; 8(3): 180-6.

Cekmez F, Aydemir G, Yildirim S, Bulut O, Tung T,

Kul M, et al. Diagnostic value of 25-hydroxyvitamin D

level and new cytokines in neonatal sepsis. Eur J

Inflamm, 2015; 12(2): 297-304.

Culic S, Markic J, Konjevoda P. Vitamin D status in

pediatric patients with newly diagnosed malignant

disease: Preliminary results. Cent Eur J Paed, 2018;

(2): 160-6.

Sano H, Kobayashi R, Iguchi A. Science direct risk

factors for sepsis-related death in children and

adolescents with hematologic and malignant diseases.

J Microbiol Immunol Infect, 2017; 50(2): 232-8.

T j o w a n t a AS , Y o e l C, L u b i s M . K a d a r

-hydroxyvitamin D sebagai penanda sepsis pada

anak. Sari Pediatri, 2017; 19(3): 150-5.

Aydemir G, Cekmez F, Kalkan G, Fidanci MK, Kaya G,

et al. High Serum 25-hydroxyvitamin D levels are

associated with pediatric sepsis. Tohoku J Exp Med,

; 234: 295-8.

WHO. Cancer in children [Internet]. 2018 Available


/detail/cancer-in-children (accssed 8 Oct, 2019).

McNally JD, Nama N, O'Heam K, Sampson M, Amrein,

et al. Vitamin D deficiency in critically ill children: A

systematic review and meta-analysis. Crit Care, 2017;

: 287.

Koekoek WAC. (Kristine), Zanten Arthur RH. Van.

Vitamin D deficiency in the critically ill. Annals of

Medicine, 2016; 48(5): 301-304.

Fethi G, Mustafa AK, Beliz B, Ahmet B, Umut KS, et al.

Serum vitamin D level variation in SIRS, sepsis and

septic shock. Marmara Medical Journal, 2019; 32(3):


Sylvia C, Puneet D. Vitamin D: Metabolism, molecular

mechanism of action, and pleiotropic effects.

Physiological Reviews, 2016; 96(1): 365-408.

Reena K, Kenneth OE. Vitamin D insufficiency/

deficiency management. South Med J. 2014; 107(2):


Salvatore C, Geir B, Andrea S, Antonia V. The role of

vitamin D in the immune system as a pro-survival

molecule. Clinical Therapeutics, 2017; 39(9): 894-916.

Naz A, Qureshi RN, Shamsi TS, Mahboob T. Vitamin D

levels in patients of acute leukemia before and after

remission-induction therapy. Pak J Med Sci, 2013;

(1): 10-4.

Sandjaja S, Budiman B, Harahap H, Ernawati F,

Soekatri M, et al. Food consumption and nutritional

and biochemical status of 0.5-12-year-old Indonesian

children: The SEANUTS study. Br J Nutr, 2013; 110:


Mostoufi MS, Ward LM. Skeletal morvidity in children

and adolescents druing and adolescents during and

following canct therapy. Horm Res Paediatr, 2019; 91;


Xu Wu, Wei Hu, Lan Lu, Yueshui Z, Yejiang Z, et al.

Repurposing vitamin D for treatment of human

malignancies via targeting tumor microenvironment.

Acta Pharmaceutica Sinica B, 2019; 9(2): 203-219.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.