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Low vitamin D may lead to poor outcomes, infections in patients with cirrhosis

Low 25-hydroxyvitamin D₃ levels were found to be associated with advanced liver disease, poor outcomes and infectious complications in patients with cirrhosis, according to study data.

“Observations in cirrhotic patients showed a poor prognosis in individuals with low [25-hydroxyvitamin D₃] levels,” the researchers wrote. “Given the fact that cirrhotic patients presenting with infections or elevated inflammatory conditions indicated by high levels of [C-reactive protein] or [soluble CD163], have an unfavorable prognosis and that expression of [toll-like receptors] inversely correlate with vitamin D levels, we hypothesized that low vitamin D levels might be associated with inflammatory responses and infectious complications in cirrhotic patients.”

Researchers analyzed data of 251 patients with cirrhosis enrolled at Frankfurt University Hospital in Germany between May 2009 and June 2011. Patients underwent blood sampling and 25-hydroxyvitamin D₃ (25(OH)D₃) levels were measured using radioimmunoassay (I125 Radioimmunoassay IA Kit, DiaSorin) on a Multi Crystal LB2111 Gamma Counter (Berthold, Germany). The mean follow-up was 411 ± 397 days.

Over the course of the study, 12% of patients underwent liver transplantation (n = 30) and 33.8% of patients died during the study (n = 85).

Approximately 68.9% of patients had very low 25(OH)D₃ levels (n=173), 23.5% had low levels (n = 59) and 7.6% of patients had normal 25(OH)D₃ levels (n = 9). The mean serum 25(OH)D₃ concentration was 8.93 ± 7.1 ng/ml.

Forty-four patients received oral vitamin D supplementation at the day of study enrollment. The mean serum 25(OH)D₃ concentration in patients with vitamin D supplementation was higher compared with patients without supplementation (12.4 ± 9.6 ng/ml vs. 8.2 ± 6.2 ng/ml; P = .003).

Researchers also found that 25(OH)D₃ levels between Child Pugh scores were different and negatively correlated with MELD score (r = – 0.277, P < .001). Patients with decompensated cirrhosis and infectious complications had lower 25(OH)D₃ levels compared with patients without complications.

Multivariate Cox regression and univariate analyses showed low 25(OH)D₃ to be associated with mortality. Vitamin D supplementation was not significantly associated with overall survival (HR = 0.841; 95% CI, 0.473-1.494).

“25(OH)D₃ deficiency is associated with advanced liver disease and low 25(OH)D₃ levels are an indicator for a poor outcome and are associated with infectious complications,” the researchers concluded. – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.