Vitamin K deficiency in critical ill patients; a prospective observational study

Sofia Dahlberg*, Leon Schurgers, Ulf Schott, Thomas Kander

*Corresponding author for this work

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Background: Vitamin K is a cofactor for proteins involved in cardiovascular health, bone metabolism and cancer. Measuring uncarboxylated prothrombin, also termed as "protein induced by vitamin K absence or antagonism for factor II (PIVKA-II)", has been used to assess vitamin K status. High levels may indicate vitamin K deficiency. The aim of this study was to measure PIVKA-II and prothrombin time (PT-INR) in intensive care (ICU) patients and correlate vitamin K status with mortality. Methods: Ninety-five patients admitted to the ICU had blood samples taken near admission and every third day. In addition to PIVKA-II and PT-INR, critical-care severity scores were computed. Results: The median baseline PIVKA-II was 4.97 mu g/L compared to the upper reference of 2.0 pg/L PIVKA-II further increased at days 3 and 6, (median 7.88 mu g/L, p = .047 and median 8.14 mu g/L, p = .011) predominantly in cardiac arrest patients (median 21.4 mu g/L, day 3). Conclusion: Intensive care patients have increased PIVKA-II levels at admission, which increases during the ICU stay, especially in cardiac arrest patients. There were no correlations between PIVKA-II and PT-INR, SOFA score or mortality. Further studies are needed to determine why PIVKA-II increases and whether high PIVKA-II levels in ICU patients affect long-term mortality or morbidity. (C) 2018 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)105-109
Number of pages5
JournalJournal of Critical Care
Publication statusPublished - Feb 2019


  • Vitamin K deficiency
  • Intensive care
  • Cardiac arrest
  • Matrix Gla protein
  • PIVKA-11

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