Micronutrient Deficiencies in Patients with Decompensated Liver Cirrhosis

Abstract

Patients with cirrhosis often develop malnutrition and micronutrient deficiencies, leading to a worse prognosis and increased mortality. Our main goal was to assess the prevalence of micronutrient deficiencies in patients with decompensated cirrhosis. This was a prospective single-center study including 125 consecutive patients hospitalized for acute decompensation of cirrhosis (mostly of alcoholic etiology). A blood test including trace elements and vitamins was performed on admission. The main micronutrient deficiencies observed were vitamin D (in 94.5%), vitamin A (93.5%), vitamin B6 (60.8%) and zinc (85.6%). Patients in Child-Pugh class C had lower levels of vitamin A (p < 0.0001), vitamin E (p = 0.01) and zinc (p < 0.001), and higher levels of ferritin (p = 0.002) and vitamin B12 (p < 0.001) than those in Child-Pugh class A and B. Patients with a higher model of end-stage liver disease (MELD) score had lower levels of vitamin A (p < 0.0001), vitamin E (p < 0.001), magnesium (p = 0.01) and zinc (p = 0.001), and higher levels of ferritin (p = 0.002) and vitamin B12 (p < 0.0001). Severe hepatic insufficiency correlated with lower levels of zinc, vitamin E and vitamin A, and higher levels of vitamin B12 and ferritin.

Keywords: decompensated cirrhosis.; malnutrition; micronutrient deficiency; trace element deficiency; vitamin deficiency.

Figure 1

Bar chart of the serum levels of the micronutrients that reached statistical significance when analyzed depending on etiology of cirrhosis as a dichotomic variable. (a) Etiology of cirrhosis and vitamin A levels. (b) Etiology of cirrhosis and vitamin B12 levels. (c) Etiology of cirrhosis and zinc levels. (d) Etiology of cirrhosis and vitamin D levels. (e) Etiology of cirrhosis and vitamin E levels. (f) Etiology of cirrhosis and copper levels.

Figure 2

Scatter plots of the correlations of MELD score with the micronutrients that reached statistical significance. R is the correlation coefficient. (a) MELD score and vitamin A (negative correlation, R = –0.37), (b) MELD score and vitamin E (negative correlation, R = –0.31), (c) MELD score and zinc (negative correlation, R = –0.21), (d) MELD score and magnesium (negative correlation, R = –0.36), (e) MELD score and ferritin (positive correlation, R = 0.28), (f) MELD score and vitamin B12 (positive correlation, R = 0.47).