Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Division of Hematology and Oncology, Department of Medicine, Université de Montréal, Montréal, Québec, Canada.
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Laboratory Medicine, OPTILAB Montréal-CHU Sainte-Justine, Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada.
J Thromb Haemost. 2024 Nov;22(11):3059-3069. doi: 10.1016/j.jtha.2024.08.002. Epub 2024 Aug 14.
Vitamin K (VK) deficiency (VKD) impairs γ-carboxylation of VK-dependent factors (VKDFs), resulting in higher factor (F)II levels measured by Ecarin (FIIE) reagents (that convert des-γ-carboxylated FII to meizothrombin) than by prothrombin time (FII) reagents.
To evaluate FII/FIIE abnormalities among patients assessed for coagulopathies and identify findings predictive of coagulopathy improvement after VK.
We retrospectively assessed consecutive cases from 2002 to 2021 with FII/FIIE tests and the sensitivity and specificity of FII/FIIE ratios and FIIE-FII differences for VKD defined as international normalized ratio correction/improvement of ≥0.5 after VK.
Two hundred ninety-two patients (males, 58.2%; adults, 85.6%; median age, 73 years) were evaluated (84.2% hospitalized, 48.3% in intensive care, 71.6% with active liver disease, and 28% deceased at discharge) and 25% to 38% had FII/FIIE findings suggestive of VKD. Among 170 patients assessed for response to VK, FII/FIIE ratios of ≤0.84 to 0.91 and FIIE-FII differences of >0.04 U/mL had similar modest sensitivity (47.7%-69.3%) and modest to good specificity (67.1%-91.5%) for VKD. FII/FIIE ratios of <0.86, suggestive of VKD (sensitivity, 47.7%; specificity, 90.2%), were more common in patients deficient in only VKDF (P = .0001), but were detected in 16% with non-VKDF deficiencies. Low FIIE was commonly associated with active liver disease (P = .0002). Patients with and without probable VKD (based on FII/FIIE ratios of <0.86) had similar mortality, bleeding, and rates of prothrombin complex concentrate and red cell transfusions (P ≥ .78), but fewer with probable VKD received plasma and fibrinogen replacement (P ≤ .024).
FII/FIIE comparison aids the diagnosis of VKD and predicts clinical responses to VK treatment among patients with coagulopathies.
维生素 K（VK）缺乏症（VKD）会损害 VK 依赖性因子（VKDF）的γ-羧化作用，导致 Ecarin（FIIE）试剂（将去γ-羧化的 FII 转化为 meizothrombin）测量的因子（F）II 水平高于凝血酶原时间（FII）试剂（F）II 水平。
评估评估凝血异常患者的 FII/FIIE 异常，并确定 VK 后凝血异常改善的预测因素。
我们回顾性评估了 2002 年至 2021 年期间接受 FII/FIIE 检测的连续病例，并评估了 FII/FIIE 比值和 FIIE-FII 差值的敏感性和特异性，以定义为 VK 后国际标准化比值校正/改善≥0.5 的 VKD。
共评估了 292 例患者（男性，58.2%；成年人，85.6%；中位年龄 73 岁）（84.2%住院，48.3%在重症监护室，71.6%有活动性肝病，28%出院时死亡），25%至 38%的患者有提示 VKD 的 FII/FIIE 发现。在 170 例接受 VK 反应评估的患者中，FII/FIIE 比值≤0.84 至 0.91 和 FIIE-FII 差值>0.04 U/mL 对 VKD 的敏感性相似（47.7%-69.3%），特异性为中度至高度（67.1%-91.5%）。<0.86 的 FII/FIIE 比值提示 VKD（敏感性为 47.7%，特异性为 90.2%）在仅缺乏 VKDF 的患者中更为常见（P=0.0001），但在 16%的非 VKDF 缺乏患者中也有发现。低 FIIE 常与活动性肝病相关（P=0.0002）。FII/FIIE 比值<0.86 的可能 VKD 患者与无可能 VKD 患者的死亡率、出血率以及凝血酶原复合物浓缩物和红细胞输注率相似（P≥0.78），但较少的可能 VKD 患者接受了血浆和纤维蛋白原替代治疗（P≤0.024）。
FII/FIIE 比较有助于 VKD 的诊断，并预测凝血异常患者对 VK 治疗的临床反应。
