Investigate 25-hydroxy vitamin D (25(OH)D) levels and the correlation with cardiovascular sequential organ failure assessment (CV-SOFA) and pediatric risk of mortality III (PRISM-III) scores in critically ill children. This prospective observational cohort study was conducted on consecutive critical ill children aged 1 month to 14 years old in 1 year. The blood sample was collected upon PICU admission. 25(OH)D deficiency was defined as<20 ng/mL. We performed univariate and multivariate analyses to evaluate associations with CV-SOFA and PRISM-III scores and other important outcomes. 296 critically ill children were enrolled in the study. The mean serum 25(OH)D level was 22.5 (IQR 16.3-31.8) ng/mL. The prevalence of 25(OH)D deficiency was 39.2% in critically ill children. 25(OH)D levels were significantly decreased in septic shock and associated with CV-SOFA and PRISM-III scores. In multivariate analysis, vitamin D deficiency is associated with CV-SOFA and PRISM-III scores. 25(OH)D deficiency is prevalent in critically ill children at PICU admission and seems to be associated with higher CV-SOFA and PRISM-III scores. Our study provides additional data for 25 (OH) D statuses that impact the outcomes of critically ill children.Copyright © 2020 Dang, Li, Liu and Xu.