{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:45:17Z","timestamp":1789055117890,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2009,7,1]],"date-time":"2009-07-01T00:00:00Z","timestamp":1246406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NCRR M01 08084"],"award-info":[{"award-number":["NCRR M01 08084"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["T32 07727"],"award-info":[{"award-number":["T32 07727"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2009,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objective:<\/jats:title><jats:p>Prothrombin time (PT), a surrogate marker of vitamin K deficiency, may underestimate the prevalence of vitamin K deficiency in cholestatic liver disease. This study investigated the frequency of vitamin K deficiency in children and adults with cholestatic liver disease by determining plasma protein induced in vitamin K absence II (PIVKA\u2010II), and assessed the relation between plasma PIVKA\u2010II levels and markers of cholestasis, measured PT, international normalized ratio (INR), serum undercarboxylated osteocalcin (ucOC), serum vitamins A and E, and serum 25\u2010hydroxyvitamin D levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods:<\/jats:title><jats:p>Blood was collected from patients with cholestatic liver disease for liver biochemistries, PT, INR, bile acids, 25\u2010hydroxyvitamin D, vitamin A, vitamin E, ucOC, and PIVKA\u2010II.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Thirty\u2010one patients were enrolled (age range 0.5\u201354 years, median age 5.7 years, 17 females). Nine patients (29%) had increased INRs, whereas 21 (68%) had elevated plasma PIVKA\u2010II levels. All patients with increased INRs had increased plasma PIVKA\u2010II. Fifteen of 21 patients with increased plasma PIVKA\u2010II were receiving supplemental vitamin K therapy (range 7.8\u2013700 \u03bcg\/kg\/day). Plasma PIVKA\u2010II levels were positively correlated with serum conjugated bilirubin, bile acids, aspartate aminotransferase, alanine aminotransferase, PT, INR, and serum ucOC (<jats:italic>P<\/jats:italic> \u2264 0.02) and negatively correlated with serum 25\u2010hydroxyvitamin D levels (<jats:italic>P<\/jats:italic> = 0.01). Twenty\u2010two patients (71%) had vitamin D deficiency, 9 patients (29%) had vitamin A deficiency, and 2 patients (6%) had vitamin E deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Despite vitamin K supplementation, elevation of plasma PIVKA\u2010II suggesting ongoing vitamin K deficiency is common in cholestatic liver disease. Better strategies for vitamin K supplementation and dosing guidelines are needed.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0b013e31819a61ff","type":"journal-article","created":{"date-parts":[[2009,6,22]],"date-time":"2009-06-22T09:08:48Z","timestamp":1245661728000},"page":"78-84","source":"Crossref","is-referenced-by-count":65,"title":["Prevalence of Subclinical Vitamin K Deficiency in Cholestatic Liver Disease"],"prefix":"10.1002","volume":"49","author":[{"given":"Jennifer","family":"Strople","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Children's Memorial Hospital Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda","family":"Lovell","sequence":"additional","affiliation":[{"name":"General Clinical Research Center Cincinnati Children's Hospital Medical Center 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