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Utilization of Des-Gamma-Carboxy-Prothrombin in Estimating Vitamin K Status in People With Cystic Fibrosis: A Single
Senthilkumar Sankararaman1, Terri Schindler2, Aravind Thavamani3
1Division of Pediatric Gastroenterology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
Insights
Assessing vitamin K status in cystic fibrosis (CF) patients using des-gamma-carboxy-prothrombin (DCP) revealed an 11.7% prevalence of deficiency. Higher DCP levels correlated with advanced CF liver disease and suspected low adherence to supplements.
Area of Science:
- Medical Research
- Nutritional Science
- Gastroenterology
Background:
- Cystic fibrosis (CF) patients face heightened risks of fat-soluble vitamin deficiencies due to exocrine pancreatic insufficiency (EPI).
- Accurate assessment of vitamin K status in CF is challenging due to the lack of a definitive clinical test.
- Des-gamma-carboxy-prothrombin (DCP) offers a potential biomarker for evaluating vitamin K status.
Purpose of the Study:
- To estimate vitamin K status in individuals with CF using DCP.
- To identify correlations between DCP levels and clinical factors in CF patients.
Main Methods:
- A retrospective chart review was conducted between 2022 and 2024.
- Ninety-four patients with CF (39 pediatric, 55 adult) were included.
- DCP levels were measured to assess vitamin K status.
Main Results:
- The median DCP level was 0.35 ng/mL, with a range of 0.1-11 ng/mL.
- 11.7% of patients exhibited elevated DCP levels (>2 ng/mL), indicating suboptimal vitamin K status.
- Higher DCP levels were associated with advanced CF liver disease (aCFLD) and suspected low adherence to pancreatic enzymes or vitamin supplementation.
Conclusions:
- DCP serves as a viable tool for estimating vitamin K status in CF patients.
- A significant prevalence of suboptimal vitamin K status (11.7%) was observed.
- Further prospective, multicenter trials are warranted to validate these findings and explore clinical implications.
Background:
People with cystic fibrosis (CF) are at increased risk of fat-soluble vitamin (A, D, E, and K) deficiencies secondary to exocrine pancreatic insufficiency (EPI). Estimation of vitamin K deficiency in routine clinical practice is challenging, and no uniform consensus exists due to lack of an accurate clinical test for the evaluation of its status. We aimed to estimate vitamin K status in people with CF using des-gamma-carboxy-prothrombin (DCP).
Methodology:
A single-center retrospective chart review was done between 2022 and 2024. Ninety-four (39 pediatric and 55 adult) people with CF were included for final review.
Results:
The median DCP value was 0.35 ng/mL (IQR 0.2-0.60; range was 0.1-11 ng/mL). Post hoc, we classified patients into low-DCP (0-90th percentile values in DCP or ≤ 2 ng/mL) and high-DCP (91-100th percentile in DCP or >2 ng/mL) groups. Eleven out of 94 (11.7%) patients had DCP > 2 ng/mL; three out of 11 (27%) had advanced CF liver disease (aCFLD), p = 0.011, and another three had other fat-soluble vitamin deficiencies, and low adherence to pancreatic enzymes and/or vitamin supplementation was suspected, p = 0.011. There were no significant differences in demographics (age, gender) or other comorbidities between the groups.
Conclusion:
DCP can be used for estimating vitamin K status, and the prevalence of suboptimal vitamin K status was 11.7%. DCP levels were higher in aCFLD, as well as those with suspected low adherence to pancreatic enzymes and/or vitamin supplementation. Prospective, multicenter clinical trials are needed to evaluate this further.
