Rapid diagnosis of coagulopathies from vitamin K deficiency in a consecutive case cohort evaluated by comparative assessment of factor II by 1-stage assays with prothrombin time vs Ecarin reagents

IF 5.5 2区医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-08-14 DOI:10.1016/j.jtha.2024.08.002

Alex Bourguignon , Natalie Mathews , Subia Tasneem , James Douketis , Catherine P.M. Hayward

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Abstract

Background

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.

Objectives

To evaluate FII/FIIE abnormalities among patients assessed for coagulopathies and identify findings predictive of coagulopathy improvement after VK.

Methods

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.

Results

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).

Conclusion

FII/FIIE comparison aids the diagnosis of VKD and predicts clinical responses to VK treatment among patients with coagulopathies.

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通过凝血酶原时间与 Ecarin 试剂的单阶段测定法对因子 II 进行比较评估，评估连续病例队列中维生素 K 缺乏所致凝血病的快速诊断。

背景：维生素 K（VK）缺乏症（VKD）会影响 VK 依赖性凝血因子（VKDF）的γ-羧化，导致用 Ecarin（FIIE）试剂（将去γ-羧化的 FII 转化为凝血酶原时间（FII）试剂）测量的因子 II（FII）水平高于凝血酶原时间（FII）试剂：评估接受凝血病评估的患者的 FII/FIIE 异常，并确定可预测 VK 后凝血病改善的结果：我们回顾性评估了 2002-2021 年间连续病例的 FII/FIIE 检测结果，以及 FII/FIIE 比率和 FIIE-FII 差异对 VKD 的敏感性和特异性，VKD 定义为 VK 后 INR 纠正/改善≥0.5。结果：292 名患者（男性 58.2%；成人 85.6%；中位年龄 73 岁）接受了评估（84.2% 住院，48.3% 重症监护；71.6% 有活动性肝病；28% 出院时死亡），25-38% 的 FII/FIIE 结果提示 VKD。在对 VK 反应进行评估的 170 名患者中，FII/FIIE 比率≤0.84-0.91 和 FIIE-FII 差异 >0.04 U/mL对于 VKD 有类似的适度敏感性（47.7-69.3%）和适度到良好的特异性（67.1-91.5%）。FII/FIIE 比值结论：FII/FIIE 比值有助于诊断 VKD 并预测凝血病患者对 VK 治疗的临床反应。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.