Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999
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.