P1256 CAN SHORT-TERM PARENTERAL VITAMIN K AMELIORATE THE PROTEIN INDUCED IN VITAMIN K ABSENCE II (PIVKA-II) IN CHILDREN WITH CHRONIC LIVER DISEASE?

Background and Aims: Children with chronic liver disease are at risk of coagulopathy due to vitamin K deficiency necessitating correction before elective invasive procedures. This study was designed to determine if parenteral vitamin k for 3 consecutive days can improve vitamin k status. Methods: Fifty patients (mean age 7.5±3.6 years) with chronic liver disease of different etiologies were enrolled. Plasma PIVKA-II concentrations basal and after 3 consecutive daily intramuscular injection of vitamin k (5–10mg/day) were measured by enzymelinked immunosorbent assay, values greater than 3ng/mL is indicative of deficiency. Results: All patients had elevated plasma PIVKA-II concentrations (>3ng/ml) though 76% of them were on oral supplementation. The mean plasma PIVKA-II after the 3 days was significantly lower than basal level: 30.1±20.8 vs60.3±25.6 ng/ml, p < 0.0001) with mean percent of change 54.4±16.9%. In 25 (50%) patients with choelstatic liver disease the mean basal plasma PIVKA-II was significantly higher than in nonchoelstatic group: 81.8±16.3 vs 38.8±10.6 ng/ml, p < 0.0001). Both groups had significant drop after the supplementation (81.8±16.3 vs47±15.6 ng/ml and 38.8±10.6 vs 13.2±6.2 ng/ml respectively, p < 0.0001). Patients with non-choelstatic liver disease showed significantly more percent of change: 66±12.9% vs42.8±11.7%, p < 0.0001). A mixed ANOVA showed significant effect of vitamin k injection (f =501.3, p < 0.0001) and significant difference between cholestatic and non-cholestatic groups (f =129.3, p < 0.0001). Conclusions: Current oral dosing regimens are not effective in meeting vitamin K needs. Parenteral supplementation for 3 days significantly improved vitamin k status in children with chronic liver disease, more in non-cholestatic patients, yet normalization wasn’t achieved. Better strategies for vitamin K supplementation are needed.