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Reduced Vitamin K Status as A Potentially Modifiable Prognostic Risk Factor in COVID-19

Sciprofile linkAnton S. M. Dofferhoff, Sciprofile linkIanthe Piscaer, Sciprofile linkLeon J. Schurgers, Sciprofile linkJona Walk, Sciprofile linkJody M. W. Van Den Ouweland, Sciprofile linkTilman M. Hackeng, Sciprofile linkPetra Lux, Sciprofile linkCecile Maassen, Sciprofile linkEsther G.A. Karssemeijer, Sciprofile linkEmiel Fm Wouters, Sciprofile linkRob Janssen
Published: 25 April 2020
Abstract: Introduction: Coronavirus 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2. The majority of patients have at most mild symptoms, however, a significant proportion develops respiratory failure. COVID-19 may also progress beyond the lungs. Coagulopathy and thromboembolism are prevalent in severe COVID-19 and relate to decreased survival. Coagulation is an intricate balance between clot promoting and dissolving processes in which vitamin K plays a well-known role. We hypothesized that vitamin K status is reduced in patients with severe COVID-19. Methods: Vitamin K status was assessed by measuring desphospho-uncarboxylated matrix Gla protein (dp-ucMGP; inversely related to vitamin K status) and the rate of elastin degradation by measuring desmosine. We included 123 patients who were admitted with COVID-19 and 184 controls. Results: Dp-ucMGP levels were significantly elevated in COVID-19 patients (1,673Å}1,584 pmol/L) compared to controls (536±291 pmol/L; p<0.0005). Dp-ucMGP levels were significantly higher in COVID-19 patients with unfavorable outcome compared to those with less severe disease. Furthermore, dp-ucMGP and desmosine levels were significantly associated (r=0.65; p<0.0005). Conclusions: Vitamin K status was reduced in patients with COVID-19 and related to poor prognosis. Also, low vitamin K status seems to be associated with accelerated elastin degradation. An intervention trial is now needed to assess whether vitamin K administration improves outcome in patients with COVID-19.
Keywords: Protein / survival / Vitamin K Status / Ucmgp / COVID
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