Prevalence of Vitamin K Deficiency in Children with Mild to Moderate Chronic Liver Disease

Abstract

Vitamin K deficiency is prevalent in children with mild to moderate chronic cholestatic liver disease, even with vitamin K supplementation. Elevated PIVKA-II levels occurred in children with a normal prothrombin, indicating that more sensitive markers of vitamin K status should be used in children with chronic liver disease. Vitamin K deficiency was related to degree of cholestasis and severity of liver disease in children. Children without cholestasis did not exhibit vitamin K deficiency.

The use of conjugated hyperbilirubinemia greater than 100 μmol/L as an indicator of irreversible liver disease in infants with short bowel syndrome

“…Although there are a number of clinical scores to determine the severity of liver disease (eg, Child [12], Pugh [13], and Paediatric End-Stage Liver Disease [PELD] [14]), none absolutely differentiates irreversible from reversible liver disease [15]. Although both the Child and Pugh scores were developed for adults and have not been specifically validated in the pediatric population, they are widely used in children [16]. Furthermore, most conventional tests of liver function (eg, bilirubin, transaminases) do not reflect hepatic reserve [15,17].…”

Vitamin K, an update for the paediatrician

“…Nevertheless, with this regimen, subclinical vitamin K deficiency seems prevalent despite normal prothrombin time (PT). In a group of 43 cholestatic children supplemented following this schedule, 23 (54%) had elevated plasma PIVKA II levels (>3 ng/ml) with normal PT [26].…”

Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease

“…Plasma PIVKA-II concentration (abnormal values indicative of suboptimal vitamin K status 42 ng/ml) was measured by an enzyme-linked immunosorbent assay kit (Diagnostica Stago, Asnières, France). The intra-assay and inter-assay coefficient of variation for this assay were 8.8% and 10.3%, respectively (Mager et al, 2006). Serum concentrations of BAP (Metra BAP; Quidel, San Diego, CA, USA), total osteocalcin (Quidel) and NTX (Osteomark NTX, Princeton, NJ, USA) were measured using commercial enzyme-linked immunosorbent assay kits.…”