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.
Crit Care. 2024 Jul 1;28(1):212. doi: 10.1186/s13054-024-05001-2.
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.
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.
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.
Addressing vitamin K deficiency in ICU patients is crucial for mitigating risks associated with critical illness, yet optimal management strategies require further investigation.
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.
维生素 K 对许多生理过程至关重要，包括凝血、骨骼代谢、组织钙化和抗氧化活性。危重病 ICU 患者中普遍存在的维生素 K 缺乏会影响凝血并增加出血和其他并发症的风险。本综述旨在阐明维生素 K 在危重病中的代谢，并确定一种潜在的治疗方法。
2023 年 12 月，使用 PRISMA 扩展的范围综述方法进行了范围综述。在 PubMed、Embase 和 Cochrane 数据库中无限制地搜索文献。纳入标准为讨论维生素 K 缺乏症和/或补充的成年 ICU 患者的研究。
共筛选了 1712 篇文章，其中 13 篇符合纳入标准。ICU 患者的维生素 K 缺乏与营养不良、吸收不良、抗生素使用、周转率增加和遗传因素有关。观察性研究表明，ICU 患者的 PIVKA-II 水平较高，表明维生素 K 状态降低。危险因素包括摄入不足、吸收不良和生理需求增加。补充研究表明，维生素 K 可以改善状态，但不能完全使其正常化。维生素 K 缺乏可能与 ICU 住院时间延长、机械通气和死亡率增加有关。遗传多态性和微生物组破坏等因素也导致缺乏，这突显了需要个体化营养策略以及进一步研究最佳补充剂量和给药途径的必要性。
在 ICU 患者中解决维生素 K 缺乏症对于降低与危重病相关的风险至关重要，但最佳管理策略需要进一步研究。
据我们所知，这是第一篇针对危重病患者维生素 K 缺乏症的患病率和进展情况进行的综述。它指导临床医生在重症监护中诊断和管理维生素 K 缺乏症，并提出了在危重病患者中补充维生素 K 的实用策略。这篇综述提供了对现有文献的全面概述，是重症医学领域的临床医生、研究人员和决策者的宝贵资源。
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