Abstract
Background Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Hepatic encephalopathy (HE) is a significant complication in liver cirrhosis patients, presenting a wide spectrum of neuropsychological symptoms. A deficiency of 25-hydroxy vitamin D (25-OHD) in the general population is associated with a loss of cognitive function, dementia, and Alzheimer's disease. Aim of the Study. Our study aims to check the relationship between low serum 25-OHD and HE in patients with HCV-related liver cirrhosis and assess its link with patient mortality. Patients and Methods. This study was observationally carried out on 100 patients with HCV-related liver cirrhosis. The patients were divided into 2 groups: Group A—included 50 HCV-related cirrhotic patients with HE, and Group B—included 50 HCV-related cirrhotic patients without HE. Assessment of disease severity using the end-stage liver disease (MELD) model and Child Turcotte Pugh (CTP) scores were done, and 25-OHD levels were measured. Comparison of vitamin D levels in different etiologies and different CTP categories was made using one-way ANOVA. Pearson's correlation between the level of vitamin D and other biomarkers was applied. Results There was a statistically significant Vitamin D level difference between the two groups. A lower level of vitamin D was observed in the HE group where the severe deficiency was 16%, while it was 6% in the other group and the moderate deficiency was 24% in HE group as compared to 10% in the other group. The insufficient vitamin D level represented 46% of the non-HE group while none of the HE group falls in this category. Vitamin D level was statistically higher in Grade 1 HE than in Grade 2 which is higher than in Grades 3 to 4. Vitamin D level was also significantly higher in those who improved from HE as compared to those who died. Conclusion The lower levels of 25-OHD were associated with the higher incidence of HE in cirrhotic HCV patients. The worsening vitamin D deficiency was associated with increased severity of the liver disease, so vitamin D may be considered a prognostic factor for the severity of liver cirrhosis and high mortality rate in HE patients.
Highlights
Hepatitis C virus (HCV) infection is a global public health problem
We tried in our research to study the relationship between low serum 25-OHD and Hepatic encephalopathy (HE) in patients with HCV-related liver cirrhosis and to evaluate whether there is a link between low serum 25OHD and mortality rate
We found that 25OHD levels were negatively correlated with both MELD and Child Turcotte Pugh (CTP) scores, suggesting that as the disease advances, 25OHD levels become more deficient (P < 0:001)
Summary
Hepatitis C virus (HCV) infection is a global public health problem. More than 185 million human beings (3% of the world’s population) are infected. HCV infection is considered the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). About fifty-five to fifty-eight percent of HCV patients develop fibrosis and cirrhosis and may deteriorate to decompensated liver cirrhosis, HE, and hepatocellular carcinoma [4]. Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Our study aims to check the relationship between low serum 25-OHD and HE in patients with HCV-related liver cirrhosis and assess its link with patient mortality. This study was observationally carried out on 100 patients with HCV-related liver cirrhosis. The lower levels of 25-OHD were associated with the higher incidence of HE in cirrhotic HCV patients. The worsening vitamin D deficiency was associated with increased severity of the liver disease, so vitamin D may be considered a prognostic factor for the severity of liver cirrhosis and high mortality rate in HE patients
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