Page 124 - Ebook-Book JCMS 2025

Prevalence of Vitamin K Deficiency in Children with Cirrhosis
Kamonphan Leksawat1,2, Songpon Getsuwan1,3*, Nongnuch Sirachainan4, Sirinapa Siwarom5, Pornthep Tan-
powpong1,3, Chatmanee Lertudomphonwanit1,3, Suporn Treepongkaruna1,3
1 Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University
2 Department of Pediatrics, Nakornping Hospital Chiang Mai
3 Ramathibodi Excellence Center in Organ Transplantation, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University
4 Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University
5 Division of Clinical Nutrition, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University
*Corresponding Author E-mail: songpon.get@mahidol.edu
Background: Abstract
Vitamin K deficiency (VKD) is common in cholestasis. However, limited studies have
demonstrated the VKD prevalence in children with cirrhosis or who receive vitamin K
prophylaxis (VKP). We aimed to identify the prevalence and factors associated with VKD in
children with cirrhosis.
Methods: A cross-sectional study included patients aged <18 years with radiologically or
pathologically confirmed cirrhosis. Diagnosis of VKD was determined by protein induced in
vitamin K absence-II (PIVKA-II) levels.
Results: We included 49 patients, most diagnosed with biliary atresia (40 patients, 81.6%), with a
median (IQR) age of 2 (1, 7) years. Thirty-five patients (71%) had abnormal PIVKA-II levels
indicating VKD, consisting of 29/36 patients (80.6 %) with cholestasis and 6/13 patients
(46.2%) without cholestasis. In patients with VKD, clinical bleeding and abnormal
international normalized ratio (INR) were found in three and seven patients, respectively.
Three patients without VKD also reported abnormal INR. Among 36 patients receiving
intramuscular VKP with a median (IQR) interval of 28 (28, 46) days, twenty-eight patients
(77.8%) had VKD. Factors associated with VKD were severe protein-energy malnutrition
(P=.02), growth stunting (P<.01), high scores for end-stage liver disease (P=.02),
hyperbilirubinemia (P<.01), and low serum albumin (P<.01). Hyperbilirubinemia and low
albumin were also associated with VKD in patients receiving VKP (P=.01 and P<0.01,
respectively). INR had a poor discriminatory capacity to predict VKD, reported with an
AuROC curve of 0.49 (95%CI: 0.34-0.64).
122 Joint Conference in Medical Sciences 2025