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. 2017 Jan;129(1-2):8-15.
doi: 10.1007/s00508-016-1127-1. Epub 2016 Nov 25.

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

Rafael Paternostro  1   2 , Doris Wagner  3 , Thomas Reiberger  1   2 , Mattias Mandorfer  1   2 , Remy Schwarzer  1   2 , Monika Ferlitsch  1   2 , Michael Trauner  2 , Markus Peck-Radosavljevic  1   2 , Arnulf Ferlitsch  4   5
Affiliations

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

Rafael Paternostro et al. Wien Klin Wochenschr. 2017 Jan.

Abstract

Background and aims: Vitamin 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.

Methods: Patients 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.

Results: A 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).

Conclusions: Vitamin 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.

Keywords: Cirrhosis; Liver dysfunction; Mortality; Portal hypertension; Vitamin D.

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Conflict of interest statement

Compliance with Ethical StandardsConflict of interestR. Paternostro, D. Wagner, T. Reiberger, M. Mandorfer, R. Schwarzer, M. Ferlitsch, M. Trauner, M. Peck-Radosavljevic and A. Ferlitsch declare that they have no competing interests.Ethical standardsThe study was performed in accordance to the current version of Helsinki Declaration and approved by the local Ethics Committee of the Medical University of Vienna and the Medical University of Graz. Since this was a retrospective study no informed consent was needed.

Figures

Fig. 1
Fig. 1
a Median 25-OH-vitamin-D3 (VIT-D) levels over groups of Child–Pugh score stages. b Median VIT-D levels in patients with and without clinical significant portal hypertension (CSPH)
Fig. 2
Fig. 2
Kaplan–Meier curve shown for all patients separated in groups with vitamin-D-deficiency (D-DEF) and without (D-NON-DEF)
Fig. 3
Fig. 3
Kaplan–Meier curve shown for patients with (a) and without (b) clinical significant portal hypertension (CSPH) separated in groups with vitamin-D deficiency (D-DEF) and without (D-NON-DEF)
Fig. 4
Fig. 4
Kaplan–Meier curve for each Child–Pugh score (CPS) stage separated in groups with vitamin-D deficiency (D-DEF) and without (D-NON-DEF)
See this image and copyright information in PMC

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