Status of Non-Thiamine B-vitamins in Children with Septic Shock from a Lower Middle Income Country: A Case-Control study

Objectives B-vitamins are increasingly being studied in management of septic shock, particularly in patients with deficiencies. However, evidence beyond thiamine remains limited. We aimed to assess status of riboflavin, niacin, pyridoxine, folate and cobalamin among children with septic shock in a lower middle-income country, and to explore their potential association with outcome. Methods Seventy-nine consecutive patients (age, 6 month − 12 years) with fluid-refractory septic shock were enrolled (period, July 2018 to December 2019) along with 22 sibling controls and 64 external controls from an immunization clinic for comparison. Children with chronic illnesses or receiving vitamin supplementation were excluded. Plasma concentrations of riboflavin, niacin, pyridoxine, folate, and cobalamin were measured at enrolment, and survival was assessed as primary outcome. Results Patients and their siblings were more stunted than external controls, both in terms of prevalence (p = 0.014) and severity (p = 0.012). Plasma levels of all five B-vitamins were significantly lower in patients than in sibling controls (all p < 0.001), which in turn had lower levels of riboflavin (p < 0.001), niacin (p < 0.001), pyridoxine (p = 0.072), folate (p = 0.070) and cobalamin (p < 0.001) compared to external controls. Among patients, non-survivors had lower levels of riboflavin (p = 0.20) and pyridoxine (p = 0.04), while folate levels were unexpectedly higher (p = 0.037). Conclusions Findings suggest that children with septic shock often come from families with pre-existing B-vitamin deficiencies, which worsen further during illness. This highlights an opportunity to evaluate adjunctive therapeutic role of B-vitamins for pediatric septic shock in low- and middle- income countries.