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Vitamin K Prescribing Trends Among Critically Ill Children Hospitalized for Sepsis: A Multicenter Observational
Corey A Fowler1, Meghan Roddy1, Elizabeth Havlicek2
1Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Insights
Vitamin K (VK) was frequently given to pediatric sepsis patients despite lacking evidence. Prescribing rates decreased slightly over time, but associated risks like hepatic dysfunction and VTE remained high.
Area of Science:
- Pediatric critical care medicine
- Pharmacology and therapeutics
- Hematology
Background:
- Vitamin K (VK) is often administered to pediatric patients with sepsis-induced coagulopathy.
- Evidence supporting VK's efficacy and safety for this specific indication is limited.
- Understanding national prescribing patterns is crucial for evidence-based practice guidelines.
Purpose of the Study:
- To analyze national trends in Vitamin K (VK) prescribing for pediatric sepsis.
- To identify patient characteristics and outcomes associated with VK use in this population.
Main Methods:
- Multicenter retrospective cohort study utilizing the Pediatric Health Information System (PHIS) registry.
- Inclusion criteria: children (0-17 years) hospitalized for sepsis in the pediatric intensive care unit (PICU) from 2016-2022.
- Analysis included VK prescribing rates, patient demographics, length of stay, and clinical outcomes (VK deficiency, hepatic insufficiency, RBC transfusion, VTE, mortality) using descriptive statistics and Joinpoint regression.
Main Results:
- Of 31,221 sepsis encounters, 14.6% received VK, with a slight annual decrease from 17.3% (2016) to 13.3% (2022).
- Patients prescribed VK showed significantly higher rates of hepatic dysfunction (20.5% vs 3.1%), RBC transfusion (26.5% vs 11.2%), VTE (12.5% vs 4.6%), and mortality (17.1% vs 4.4%).
- The median length of stay was longer for patients receiving VK (16 days vs 8 days). VK deficiency was rare (0.2%).
Conclusions:
- Vitamin K (VK) administration is common in critically ill children with sepsis, despite a lack of robust clinical trial evidence.
- The study highlights a need for prospective trials to establish the efficacy and safety of VK for sepsis-induced coagulopathy in pediatric patients.
- Current prescribing practices may not align with evidence-based guidelines, necessitating further research and guideline refinement.
Abstract:
Objective: Vitamin K (VK) is commonly prescribed for pediatric sepsis-induced coagulopathy without trial-derived evidence to support its use for this indication. The purpose of this study was to characterize national prescribing trends for VK in this population. Patients and Methods: This is a multicenter retrospective cohort study using the Pediatric Health Information System registry including children 0 to 17 years of age hospitalized for sepsis in the pediatric intensive care unit from January 2016 through December 2022. The primary outcome was overall, annual, and center-specific VK prescribing rates. Descriptive data included demographics, length of stay, and rates of VK deficiency, hepatic insufficiency, red blood cell (RBC) transfusion, venous thromboembolism (VTE), and mortality. VK prescribing trends were assessed using Joinpoint regression. Descriptive statistics employed included Wilcoxon rank-sum, student's t, and chi-square tests. Results: Of the 31 221 encounters studied, 4539 (14.6%) were prescribed VK (median center-specific rate: 14.2%; interquartile range [IQR]: 8.8-21%) with a linear annual trend decreasing from 17.3% in 2016 to 13.3% in 2022 (-0.6%/year, r2 = .661). Those prescribed VK had greater rates of hepatic dysfunction (20.5% vs 3.1%), RBC transfusion (26.5% vs 11.2%), VTE (12.5% vs 4.6%), mortality (17.1% vs 4.4%), and median length of stay (16 [IQR: 8-33] vs 8 [4-15] days) (all P < .001). VK deficiency was diagnosed in 0.2% of encounters. Conclusions: In this multicenter retrospective cohort, VK prescribing was common among critically ill children diagnosed with sepsis. Phased trials are needed to demonstrate clinical efficacy and safety for VK in this population.
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