Mager, D R; McGee, P L; Roberts, E A; Furuya, K N

Journal of Pediatric Gastroenterology & Nutrition: October 1999 - Volume 29 - Issue 4 - p 508
Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999

Division of Gastroenterology and Nutrition and The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.

Article Outline

Abstract 78

Children with liver disease are at risk for developing vitamin K deficiency secondary to fat malabsorption and inadequate dietary intake. The aim of this study was to assess vitamin K status in cholestatic (n=22) and non-cholestatic (n=20) children with liver disease. Mean age (± SD) of children in the study was 8.27 ± 5.52 years. 12/42 children were supplemented with vitamin K in the form of a multivitamin (0.2 mg/d) or a single vitamin preparation (5 mg, 2 to 7 times/week). Vitamin K status was assessed by plasma PIVKA-II (prothrombin induced in vitamin K absence) levels (ELISA assay, a sensitive marker of vitamin K). Baseline blood work (prothrombin time (PT), alk phos, γ-GT, AST, conjugated/unconjugated/delta bilirubin, bile salts, albumin, vitamin A and E) was obtained to assess the relationship of vitamin K status to the biochemical parameters. Severity of liver disease was assessed by the Child-Turcotte classification and modified Pugh score. Mean plasma PIVKA-II in children with cholestatic and non-cholestatic liver disease was 58.9 ± 112.6 and 0.03 ± 0.18 ng/ml, respectively. 10/22 (45%) cholestatic children had plasma PIVKA-II values > than 2 ng/ml (reflects vitamin K deficiency), while only 1 child had a prolonged PT. Conjugated, delta, and total bilirubins, Child-Turcotte classification and Pugh scores positively correlated with plasma PIVKA II levels (p<0.05) in all patients studied. There was a negative correlation between albumin and plasma PIVKA-II levels in cholestatic children (p<0.05). No significant correlation was found between plasma PIVKA-II levels and the other biochemical parameters measured. Conclusion: This pilot study demonstrates that sub-clinical vitamin K deficiency is prevalent in children with chronic cholestatic liver disease. Elevated PIVKA-II levels occurred in the presence of a normal PT, indicating that PT is not an adequate marker of vitamin K status in children with liver disease. Furthermore, we found that Vitamin K deficiency was associated with the degree of cholestasis and severity of liver disease.

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© 1999 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,