Low 25-OH-vitaminD levels reflect hepatic dysfunction and are associated with mortality in patients with liver cirrhosis.

Rafael Paternostro,Arnulf Ferlitsch,Monika Ferlitsch,Markus Peck-Radosavljevic,Doris Wagner,Thomas Reiberger,Remy Schwarzer,Mattias Mandorfer,Michael Trauner

doi:10.1007/s00508-016-1127-1

Rafael Paternostro, Arnulf Ferlitsch + Show 7 more

Open Access

https://doi.org/10.1007/s00508-016-1127-1

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Abstract

SummaryBackground and aimsVitamin D deficiency is frequent in patients with cirrhosis. The aims of this study were to evaluate the relation of vitamin D status to portal hypertension, degree of liver dysfunction and survival.MethodsPatients with cirrhosis who have been tested for 25-OH-vitamin D levels were retrospectively included. Vitamin D deficiency was defined as 25-OH-vitamin D levels <10 ng/ml. Child–Pugh score, model for end-stage liver disease (MELD) and available hepatic venous pressure gradient (HVPG) were recorded. Mortality was documented during follow-up.ResultsA total of 199 patients were included. Prevalence of vitamin D deficiency (<10 ng/ml) was 40% (79/199), with 14% in Child–Pugh stage A, 39% in Child–Pugh stage B and 47% in Child–Pugh stage C (p = 0.001). Vitamin D deficiency was more common in patients with clinically significant portal hypertension (CSPH, HVPG ≥ 10 mm Hg) than in patients without (43.5% vs. 24.4%, p = 0.025). Significantly more deaths were observed in patients with vitamin D deficiency (32.9%, 26/79 vs. 13.3%, 16/120; p = 0.001). COX regression found presence of hepatocellular carcinoma (p < 0.001; HR: 5.763 95%CI:2.183–15.213), presence of CSPH (p = 0.026; HR: 5.487 95%CI: 1.226–24.55) and Child–Pugh stage C (p = 0.003; HR:5.429 95%CI: 1.771–16.638) as independent risk factors for mortality. Furthermore we could show a tendency towards group vitamin D deficiency being an independent risk factor (p = 0.060; HR: 1.86 95%CI:0.974–3.552).ConclusionsVitamin D levels progressively decrease in more advanced Child stages and in patients with increasing HVPG. Vitamin D deficiency might be a valuable predictor of mortality in cirrhosis.

Highlights

Liver cirrhosis is the cause of around 170,000 deaths per year in Europe, whereas liver cancer is responsible for around 47,000 deaths per year in the EU [1], while a recent report suggests that even this might be an underestimation [2]
78.4% of all patients were found with clinical significant portal hypertension (CSPH)
We found significant correlations of absolute VIT-D with hepatic venous pressure gradient (HVPG) values (p < 0.001, r = –0.360) as well as presence of CSPH (p = 0.001, r = –0.235)

Summary

Introduction

Liver cirrhosis is the cause of around 170,000 deaths per year in Europe, whereas liver cancer is responsible for around 47,000 deaths per year in the EU [1], while a recent report suggests that even this might be an underestimation [2]. There are several risk factors for developing complications of cirrhosis such as ascites, hepatic encephalopathy, and GI bleeding. Portal hypertension is the triggering factor for those complications most of the time since it decreases liver function and encourages complications to begin [3]. The liver plays a crucial role in the biosynthesis of active vitamin-D3 E., calcitriol or 1,25-OH vitaminD3) via hydroxylation to 25-OH-vitamin-D3. The final hydroxylation step to produce 1,25-OH-vitamin-D3 is done in the kidney, 25-OH-vitamin-D3 (= VIT-D)—as synthesized by the liver—is the most commonly used biomarker to measure vitamin-D status in patients, given its half-life [4]. Other than that 25-OH-vitamin-D3 is a key modulator of bone growth and remodeling [5]

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