Vitamin K deficiency and D-dimer levels in the intensive care unit: a prospective cohort study.
Patients in the intensive care unit (ICU) are at risk for the development of vitamin K deficiency. We sought to determine the frequency of this deficiency by performing a prospective cohort study in which patients were screened for vitamin K deficiency on ICU admission and every other day thereafter. Vitamin K deficiency was diagnosed by a functional coagulation factor II to Echis factor II ratio < 0.70. Activity of the coagulation cascade was measured by D-dimer. In total, 40 patients were enrolled into the study. Seven of the patients had ratios < 0.70 on the day of admission to the ICU, and three patients developed ratios < 0.70. Thus, 10 of 40 patients (25%; 95% confidence interval, 12-38%) had vitamin K deficiency. Two patients developed coagulopathy, as indicated by an International Normalized Ratio of more than 1.4. D-dimer levels were elevated in 86 of 111 samples. We conclude that vitamin K deficiency is common among critically ill patients, particularly on admission to the ICU. Our findings suggest that additional clinical research is warranted to determine whether vitamin K supplementation on admission to the ICU reduces the risk of ICU-acquired vitamin K deficiency and its attendant complications over the course of the ICU stay.
Crowther
M A
MA
Department of Medicine, McMaster University, St Joseph's Hospital, Hamilton, Ontario, Canada. crowthrm@mcmaster.ca
McDonald
E
E
Johnston
M
M
Cook
D
D
D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000097:blood / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006470:Hemorrhage / Q000097:blood / Q000209:etiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014813:Vitamin K Deficiency / Q000175:diagnosis / Q000453:epidemiology*
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D