Association Between Serum 25OH-Vitamin D and Heart Involvement in a Sin-Gle-Centre Cohort of Children with Acute Rheumatic Fever During the Years 2004–2024

Background: An aberrant immune response against Streptococcus pyogenes combined with yet unraveled genetic inference can provoke acute rheumatic fever (ARF), but clues determining the specific development of rheumatic heart disease (RHD) are obscure. Objectives: To assess general and laboratory data at the onset of ARF in a single-centre cohort of children managed between 2004 and 2024, and retrospectively evaluate any potential relationship with the occurrence of RHD. Patients and methods: Children with ARF diagnosed according to the revised Jones criteria, all having a follow-up duration of >5 years and managed at the Department of Life Sciences and Public Health in our University, were included. Retrospective data from their medical records were assessed. Out of 90 eligible patients, 12 were dismissed; a total number of 78 consecutive children with ARF (39 males) with a mean age of 127.7±33 months was considered. Their demographic, clinical, and laboratory variables at disease onset, including C-reactive protein, anti-streptolysin-O titer and 25-hydroxyvitamin D 25(OH)-vitamin D were analyzed. Results: Sixty-six children (84.6% of the whole cohort) were found to have echocardiographic evidence of RHD. Univariate analysis showed that diagnosis of RHD was significantly associated with 25(OH)-vitamin D deficiency. Vitamin D levels lower than 30 ng/mL were found to be the only variable, among those analyzed in this study, associated with RHD after a multivariable logistic analysis adjusted for sex and age. No relationship with the month of the year at diagnosis of ARF and RHD was found. Conclusions: Hypovitaminosis D has been identified as a factor potentially associated with RHD occurrence and severity in a single-center cohort of children with ARF evaluated over two decades. This result suggests that vitamin D deficiency might play a role on the occurrence of carditis in ARF.