1
|
Paulus MC, Drent M, Kouw IWK, Balvers MGJ, Bast A, van Zanten ARH. Vitamin K: a potential missing link in critical illness-a scoping review. Crit Care 2024; 28:212. [PMID: 38956732 PMCID: PMC11218309 DOI: 10.1186/s13054-024-05001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Vitamin K is essential for numerous physiological processes, including coagulation, bone metabolism, tissue calcification, and antioxidant activity. Deficiency, prevalent in critically ill ICU patients, impacts coagulation and increases the risk of bleeding and other complications. This review aims to elucidate the metabolism of vitamin K in the context of critical illness and identify a potential therapeutic approach. METHODS In December 2023, a scoping review was conducted using the PRISMA Extension for Scoping Reviews. Literature was searched in PubMed, Embase, and Cochrane databases without restrictions. Inclusion criteria were studies on adult ICU patients discussing vitamin K deficiency and/or supplementation. RESULTS A total of 1712 articles were screened, and 13 met the inclusion criteria. Vitamin K deficiency in ICU patients is linked to malnutrition, impaired absorption, antibiotic use, increased turnover, and genetic factors. Observational studies show higher PIVKA-II levels in ICU patients, indicating reduced vitamin K status. Risk factors include inadequate intake, disrupted absorption, and increased physiological demands. Supplementation studies suggest vitamin K can improve status but not normalize it completely. Vitamin K deficiency may correlate with prolonged ICU stays, mechanical ventilation, and increased mortality. Factors such as genetic polymorphisms and disrupted microbiomes also contribute to deficiency, underscoring the need for individualized nutritional strategies and further research on optimal supplementation dosages and administration routes. CONCLUSIONS Addressing vitamin K deficiency in ICU patients is crucial for mitigating risks associated with critical illness, yet optimal management strategies require further investigation. IMPACT RESEARCH To the best of our knowledge, this review is the first to address the prevalence and progression of vitamin K deficiency in critically ill patients. It guides clinicians in diagnosing and managing vitamin K deficiency in intensive care and suggests practical strategies for supplementing vitamin K in critically ill patients. This review provides a comprehensive overview of the existing literature, and serves as a valuable resource for clinicians, researchers, and policymakers in critical care medicine.
Collapse
Affiliation(s)
- Michelle Carmen Paulus
- Department of Intensive Care Medicine & Research, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
- Division of Human Nutrition and Health, Nutritional Biology, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Marjolein Drent
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Science, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Interstitial Lung Diseases (ILD) Center of Excellence, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
- ILD Care Foundation Research Team, Heideoordlaan 8, 6711NR, Ede, The Netherlands
| | - Imre Willemijn Kehinde Kouw
- Department of Intensive Care Medicine & Research, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
- Division of Human Nutrition and Health, Nutritional Biology, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Michiel Gerard Juliaan Balvers
- Division of Human Nutrition and Health, Nutritional Biology, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Aalt Bast
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine, and Life Science, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- ILD Care Foundation Research Team, Heideoordlaan 8, 6711NR, Ede, The Netherlands
| | - Arthur Raymond Hubert van Zanten
- Department of Intensive Care Medicine & Research, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
- Division of Human Nutrition and Health, Nutritional Biology, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
| |
Collapse
|
2
|
Ren Q, Zhao J, He X, Su L, Chai J, Bai L, Ao Z, Wu C, Guan X, Xie Y, Kong Y, Li L, Liu Z. Plasma transfusion in critically Ill patients with abnormal coagulation tests before invasive procedures: A propensity-adjusted cohort study. Transfus Apher Sci 2023:103700. [PMID: 36941167 DOI: 10.1016/j.transci.2023.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE To evaluate the association between plasma transfusion and bleeding complications in critically ill patients with an elevated international normalized ratios undergoing invasive procedures. METHODS A retrospective study was conducted to evaluate a consecutive sample of critically ill adult patients undergoing invasive procedures (N = 487) with an international normalized ratio ≥ 1.5 between January 1, 2019 and December 31, 2019. Among the followed patients, 125 were excluded due to incomplete case records and 362 were finally included in this investigation. The exposure was whether plasma had been transfused within 24 h before the invasive procedure. The primary outcome was the occurrence of postprocedural bleeding complications. Secondary outcomes included transfusion of red blood cells within 24 h of the invasive procedure, and additional patient-important outcomes such as mortality and length of stay. Tests were performed with univariate and propensity-matched analyses. RESULTS Of the 362 study participants, 99 (27.3 %) received a preprocedural plasma transfusion. In the propensity score-matched analysis, the rate of the occurrence of postprocedural bleeding complications between two groups was not statistically different (OR, 0.605[95 % CI, 0.341-1.071]; P = .085). The rate of postoperative red blood cell transfusion in the plasma transfusion group was higher than that in the non-plasma transfusion group (35.5 % vs 21.5 %; P < .05). No statistically significant difference in mortality was observed between the two groups (29.0 % vs 31.6 %; P = .101). CONCLUSIONS Prophylactic plasma transfusion failed to reduce postprocedural bleeding complications in ill critically patients with a coagulopathy. Meanwhile, it was associated with increased red blood cell transfusion after invasive procedures. Findings suggest that abnormal preprocedural international normalized ratios should be managed more conservatively.
Collapse
Affiliation(s)
- Qi Ren
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China; Zhongshan Central Blood Station, 528405 Zhongshan, Guangdong Province, PR China
| | - Jie Zhao
- Sichuan Provincial People's Hospital, 610072 Chengdu, Sichuan Province, PR China
| | - Xuehua He
- Shanxi Bethune Hospital, 030032 Taiyuan, Shanxi Province, PR China
| | - Li Su
- Guizhou Provincial People's Hospital, 550002 Guiyang, Guizhou Province, PR China
| | - Juchuan Chai
- Zibo Central Hospital, 255020 Zibo, Shandong Province, PR China
| | - Lingling Bai
- The Third People's Hospital of Chengdu, 610014 Chengdu, Sichuan Province, PR China
| | - Zhengcai Ao
- Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan Province, PR China
| | - Caixia Wu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China
| | - Xiaoyu Guan
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China
| | - Yudi Xie
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China
| | - Yujie Kong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China
| | - Ling Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China.
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, 610052 Chengdu, Sichuan Province, PR China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, 610052 Chengdu, Sichuan Province, PR China.
| |
Collapse
|
3
|
Tavares MF, DeMarinis S, Cheves TA, Sweeney JD. Elevated INR in the ICU and plasma transfusion. Transfusion 2022; 62:508-510. [PMID: 35146765 DOI: 10.1111/trf.16779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Maria F Tavares
- Transfusion Service, Department of Pathology, Roger Williams Hospital, Providence, Rhode Island, USA
| | - Sandra DeMarinis
- Department of Transfusion Medicine and Coagulation, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Tracey A Cheves
- Department of Transfusion Medicine and Coagulation, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Joseph D Sweeney
- Transfusion Service, Department of Pathology, Roger Williams Hospital, Providence, Rhode Island, USA.,Department of Transfusion Medicine and Coagulation, Rhode Island Hospital, Providence, Rhode Island, USA
| |
Collapse
|