P1.010: Vitamin K Administration During Pediatric Sepsis: A Single Center Observational Study

Background: Vitamin k, an essential clotting cofactor, is frequently prescribed for sepsis-induced coagulopathy. To date, no pediatric clinical trials of vitamin k have been conducted for this indication and no observational data report the presence of sepsis-related vitamin k deficiency. We aimed to estimate the vitamin k prescribing rate for pediatric sepsis, characterize those in receipt thereof, and assess for variance in clinical outcomes by vitamin k exposure.

Methods: We performed a single-center, retrospective cohort study at a tertiary pediatric referral center including children < 18 years of age hospitalized for sepsis (defined by the Improving Pediatric Sepsis Outcomes initiative) between 06/01/2022-06/01/2024. We excluded children with short-gut syndrome, cystic fibrosis, chronic vitamin k supplementation, and chronic hepatic dysfunction. The primary outcome was the aggregate vitamin k prescription rate. Secondary outcomes were clinically-relevant bleeding and hospital-acquired venous thromboembolism rates defined by the International Society of Thrombosis and Haemostasis. Descriptive data included demographics, anthropometrics, admission international normalized ratio (INR) values, and inpatient outcomes (e.g., rates of mortality, invasive ventilation, and length of stay [LOS]). Summative and comparative statistics were employed. Type I error was set at 0.05, all tests were two sided, and missing data were not imputed.

Results: Of 285 children studied, 65 (22.8%) were prescribed vitamin K at a mean dose of 4.2±1.9 mg/day. Only 104 (36.5%) children had INR tested at admission (including 52 of 65 [80%] prescribed vitamin k). INR values were higher for those in receipt of vitamin k as compared to not (median 1.63 [interquartile range, IQR:1.38-1.97] versus 1.26 [IQR:1.13-1.35], p< 0.001). Table 1 lists general descriptive and outcomes data. Those in receipt of vitamin k, as compared to not, experienced elevated rates of clinically relevant bleeding (30.8% versus 5.9%, p< 0.001), venous thromboembolism (21.5% versus 7.7%, p=0.005), and frequently required packed red blood cells (60% versus 11.8%) and plasma (35.4% versus 0.5%) (both p< 0.001). Compared to those not prescribed vitamin k, those in receipt thereof were older (median age in years: 7 [IQR:2-13] versus 3.5 [IQR:1-11], p=0.015), were admitted postoperatively (15.4% versus 5.5%, p=0.015), had acute hepatic dysfunction (12.3% versus 0.5%, p< 0.001), and had a more severe clinical trajectory as evident by elevate rates of invasive ventilation (56.9% versus 16.4%, p< 0.001), central venous catheterization (47.7% versus 13.6%, p< 0.001), mortality (10.8% versus 1.8%, p=0.004), and median hospital LOS (23 [IQR:10-36] versus 7 [IQR:4-1] days, p< 0.001).

Conclusion: In this single-center report, children hospitalized for sepsis frequently received vitamin k (22.8%) notwithstanding the relative absence of laboratory data to infer coagulopathy. Future research must prospectively confirm the presence and magnitude of vitamin k deficiency at presentation for children with pediatric sepsis and, in subsequent controlled trials, determine the safety and efficacy of vitamin k for this indication.