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Abstract：
OBJECTIVE: Vitamin K deficiency, expressed by a high level of desphospho-uncarboxylated matrix GLA protein (dp-ucMGP), is highly prevalent in dialysis patients. However, the predictive ability of the vitamin K status remains unclear in continuous ambulatory peritoneal dialysis (CAPD) patients.
METHODS: 158 prevalent CAPD patients with a median level of dp-ucMGP of 1093 (752, 1485) pmol/L were enrolled. Patient outcomes including all-cause mortality and cardiovascular events (CVEs) were recorded during follow-up. Survival curves were performed using Kaplan-Meier method, and the influences of dp-ucMGP on outcomes were analyzed by Cox regression models.
RESULTS: A total of 59 deaths and 82 new episodes of CVEs occurred during median follow-up of 31.4 ± 13.1 months (range: 3.8-48.0 months). Kaplan-Meier analysis revealed patients with higher dp-ucMGP levels (≥ 1093 pmol/L) had an increased risk for both mortality (P = 0.005) and CVEs (P < 0.001). Multivariable Cox regression confirmed that higher dp-ucMGP levels increase the mortality risk [hazard ratio (HR), 1.763; 95% CI 1.045-3.291] and CVEs (HR, 1.846; 95% CI 1.074-3.172). For every 100 pmol/L increase in serum dp-ucMGP, the adjusted HRs for mortality and CVEs were 1.054 (95% CI 1.008-1.106) and 1.034 (95% CI 1.012-1.089), respectively.
CONCLUSIONS: Vitamin K deficiency, as expressed by high dp-ucMGP levels, showed independently associations with mortality and CVEs in CAPD patients.
METHODS: 158 prevalent CAPD patients with a median level of dp-ucMGP of 1093 (752, 1485) pmol/L were enrolled. Patient outcomes including all-cause mortality and cardiovascular events (CVEs) were recorded during follow-up. Survival curves were performed using Kaplan-Meier method, and the influences of dp-ucMGP on outcomes were analyzed by Cox regression models.
RESULTS: A total of 59 deaths and 82 new episodes of CVEs occurred during median follow-up of 31.4 ± 13.1 months (range: 3.8-48.0 months). Kaplan-Meier analysis revealed patients with higher dp-ucMGP levels (≥ 1093 pmol/L) had an increased risk for both mortality (P = 0.005) and CVEs (P < 0.001). Multivariable Cox regression confirmed that higher dp-ucMGP levels increase the mortality risk [hazard ratio (HR), 1.763; 95% CI 1.045-3.291] and CVEs (HR, 1.846; 95% CI 1.074-3.172). For every 100 pmol/L increase in serum dp-ucMGP, the adjusted HRs for mortality and CVEs were 1.054 (95% CI 1.008-1.106) and 1.034 (95% CI 1.012-1.089), respectively.
CONCLUSIONS: Vitamin K deficiency, as expressed by high dp-ucMGP levels, showed independently associations with mortality and CVEs in CAPD patients.
摘要：
目标：维生素K缺乏，由高水平的去磷酸化-未羧化基质GLA蛋白（dp-ucMGP）表达，在透析患者中非常普遍。然而,在持续性非卧床腹膜透析(CAPD)患者中,维生素K状态的预测能力尚不清楚.
方法：纳入158名dp-ucMGP中位数为1093(752,1485)pmol/L的CAPD患者。随访期间记录患者结局，包括全因死亡率和心血管事件（CVEs）。生存曲线采用Kaplan-Meier法，采用Cox回归模型分析dp-ucMGP对结局的影响。
结果：中位随访时间为31.4±13.1个月（范围：3.8-48.0个月），共发生59例死亡和82例新发CVE。Kaplan-Meier分析显示，dp-ucMGP水平较高（≥1093pmol/L）的患者死亡率（P=0.005）和CVE（P<0.001）的风险均增加。多变量Cox回归证实，较高的dp-ucMGP水平会增加死亡风险[危险比（HR），1.763；95%CI1.045-3.291]和CVE(HR，1.846；95%CI1.074-3.172）。血清dp-ucMGP每增加100pmol/L，死亡率和CVE的调整后HR分别为1.054(95%CI1.008-1.106)和1.034(95%CI1.012-1.089)，分别。
结论：维生素K缺乏，以高dp-ucMGP水平表示，显示与CAPD患者的死亡率和CVE独立相关。
方法：纳入158名dp-ucMGP中位数为1093(752,1485)pmol/L的CAPD患者。随访期间记录患者结局，包括全因死亡率和心血管事件（CVEs）。生存曲线采用Kaplan-Meier法，采用Cox回归模型分析dp-ucMGP对结局的影响。
结果：中位随访时间为31.4±13.1个月（范围：3.8-48.0个月），共发生59例死亡和82例新发CVE。Kaplan-Meier分析显示，dp-ucMGP水平较高（≥1093pmol/L）的患者死亡率（P=0.005）和CVE（P<0.001）的风险均增加。多变量Cox回归证实，较高的dp-ucMGP水平会增加死亡风险[危险比（HR），1.763；95%CI1.045-3.291]和CVE(HR，1.846；95%CI1.074-3.172）。血清dp-ucMGP每增加100pmol/L，死亡率和CVE的调整后HR分别为1.054(95%CI1.008-1.106)和1.034(95%CI1.012-1.089)，分别。
结论：维生素K缺乏，以高dp-ucMGP水平表示，显示与CAPD患者的死亡率和CVE独立相关。
