Stephens Katy, Miller Jamie L, Harkin Maura, Neely Stephen B, Haws Laura, Johnson Peter N
Department of Pharmacy (KS, MH), Oklahoma Children's Hospital at OU Health, Oklahoma City, OK.
Department of Pharmacy: Clinical and Administrative Sciences (JLM, SBN, PNJ), College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
J Pediatr Pharmacol Ther. 2023;28(5):423-429. doi: 10.5863/1551-6776-28.5.423. Epub 2023 Oct 3.
The purpose of this study was to evaluate phytonadione in children with septic shock with disseminated intravascular coagulopathy (DIC). The primary objective was to identify the number of patients with an international normalized ratio (INR), defined as ≤1.2, following phytonadione. Secondary objectives were to compare patients who achieved a normalized INR versus those with INR >1.2 and to determine factors associated with a normalized INR.
A retrospective study of children <18 years of age receiving phytonadione from October 1, 2013, to August 31, 2020, with a diagnosis of septic shock, were included. Data collection included demographics, phytonadione regimen, INR values, Pediatric Index of Mortality 2 (PIM2) and Pediatric Risk of Mortality III (PRISM III) scores, fresh frozen plasma (FFP) and cryoprecipitate use. A logistic regression model and generalized linear model were used to explore factors associated with a normalized INR and evaluate phytonadione dosing.
Data for initial phytonadione course for 156 patients were evaluated. Sixty-six (42.3%) patients had a normalized INR. Most patients (n = 145; 92.9%) received ≤3 phytonadione doses, with the largest reduction in INR occurring after the second dose. In the logistic regression model, baseline INR, FFP, cryoprecipitate, vasopressors, PIM2, PRISM III, or cumulative phytonadione dose were not associated with achieving a normalized INR.
Less than half of patients achieved a normalized INR. The median cumulative dose of phytonadione and receipt of FFP or cryoprecipitate was not associated with an increased odds of a normalized INR. Future studies are needed to further explore phytonadione use in children with sepsis-induced coagulopathy.
本研究旨在评估维生素K1在患有脓毒性休克合并弥散性血管内凝血（DIC）的儿童中的应用情况。主要目的是确定在使用维生素K1后国际标准化比值（INR）≤1.2的患者数量。次要目的是比较INR恢复正常的患者与INR>1.2的患者，并确定与INR恢复正常相关的因素。
对2013年10月1日至2020年8月31日期间接受维生素K1治疗且诊断为脓毒性休克的18岁以下儿童进行回顾性研究。数据收集包括人口统计学资料、维生素K1治疗方案、INR值、小儿死亡率指数2（PIM2）和小儿死亡风险Ⅲ（PRISMⅢ）评分、新鲜冰冻血浆（FFP）和冷沉淀的使用情况。采用逻辑回归模型和广义线性模型来探索与INR恢复正常相关的因素，并评估维生素K1的给药剂量。
对156例患者维生素K1初始疗程的数据进行了评估。66例（42.3%）患者的INR恢复正常。大多数患者（n = 145；92.9%）接受的维生素K1剂量≤3剂，INR的最大降幅出现在第二剂之后。在逻辑回归模型中，基线INR、FFP、冷沉淀、血管加压药、PIM2、PRISMⅢ或维生素K1累积剂量与INR恢复正常无关。
不到一半的患者INR恢复正常。维生素K1的中位累积剂量以及FFP或冷沉淀的使用与INR恢复正常的几率增加无关。未来需要进一步研究以进一步探索维生素K1在脓毒症诱导的凝血病儿童中的应用。
