Vitamin K deficiency in critical ill patients; a prospective observational study
Sofia Dahlberg1, Leon Schurgers2, Ulf Schött3
1Institution of Clinical Sciences Lund, Medical Faculty, Lund University, S-22185 Lund, Sweden..
Insights
Intensive care patients show elevated vitamin K deficiency markers (PIVKA-II) upon admission and throughout their stay, particularly those with cardiac arrest. These levels did not correlate with mortality or severity scores.
Area of Science:
- Biochemistry
- Critical Care Medicine
- Nutritional Science
Background:
- Vitamin K is essential for proteins regulating cardiovascular health, bone metabolism, and cancer.
- Protein Induced by Vitamin K Absence or Antagonism for Factor II (PIVKA-II) is a biomarker for vitamin K status.
- Elevated PIVKA-II levels suggest potential vitamin K deficiency.
Purpose of the Study:
- To measure PIVKA-II and PT-INR in intensive care unit (ICU) patients.
- To assess vitamin K status in critically ill patients.
- To correlate vitamin K status with patient mortality.
Main Methods:
- Blood samples were collected from 95 ICU patients at admission and every third day.
- PIVKA-II and PT-INR levels were measured.
- Critical-care severity scores (e.g., SOFA) were computed.
Main Results:
- Median baseline PIVKA-II levels (4.97 μg/L) exceeded the upper reference limit (2.0 μg/L).
- PIVKA-II levels increased significantly at days 3 and 6 of ICU stay (p < 0.05).
- Cardiac arrest patients exhibited markedly higher PIVKA-II levels (median 21.4 μg/L on day 3).
Conclusions:
- ICU patients exhibit elevated PIVKA-II levels, which increase during hospitalization, especially in cardiac arrest cases.
- No correlation was found between PIVKA-II, PT-INR, SOFA score, or mortality.
- Further research is required to understand the implications of increasing PIVKA-II levels in ICU patients on long-term outcomes.
Background:
Vitamin K is a cofactor for proteins involved in cardiovascular health, bone metabolism and cancer. Measuring uncarboxylated prothrombin, also termed as "protein induced by vitamin K absence or antagonism for factor II (PIVKA-II)", has been used to assess vitamin K status. High levels may indicate vitamin K deficiency. The aim of this study was to measure PIVKA-II and prothrombin time (PT-INR) in intensive care (ICU) patients and correlate vitamin K status with mortality.
Methods:
Ninety-five patients admitted to the ICU had blood samples taken near admission and every third day. In addition to PIVKA-II and PT-INR, critical-care severity scores were computed.
Results:
The median baseline PIVKA-II was 4.97 μg/L compared to the upper reference of 2.0 μg/L. PIVKA-II further increased at days 3 and 6, (median 7.88 μg/L, p = .047 and median 8.14 μg/L, p = .011) predominantly in cardiac arrest patients (median 21.4 μg/L, day 3).
Conclusion:
Intensive care patients have increased PIVKA-II levels at admission, which increases during the ICU stay, especially in cardiac arrest patients. There were no correlations between PIVKA-II and PT-INR, SOFA score or mortality. Further studies are needed to determine why PIVKA-II increases and whether high PIVKA-II levels in ICU patients affect long-term mortality or morbidity.
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