Vitamin D Is Associated with Clinical Outcomes in Patients with Primary Biliary Cholangitis

Abstract

Vitamin D (VD) deficiency has been associated with clinical outcomes in patients with chronic liver disease. This study aims to identify the prevalence of VD deficiency in patients with primary biliary cholangitis (PBC) and its association with treatment response to ursodeoxycholic acid (UDCA), cirrhosis development, and liver-related events (mortality and liver transplantation). Two hundred and fifty-five patients with PBC diagnosis were evaluated. Patients with VD levels below 50 nmol/L were defined as deficient. Treatment response to UDCA was defined according to the Toronto criteria. Independent risk factors were identified using binary logistic and Cox regression analysis. The mean level of serum VD was 77 ± 39 nmol/L, and 64 patients (25%) were VD deficient. Incomplete response to UDCA was more prevalent in VD-deficient patients compared to their counterparts (45% vs. 22%; p < 0.001). The risk of cirrhosis development (hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.17-3.19, p = 0.01) and liver-related mortality or need for liver transplantation (HR 3.33, 95% CI, 1.57-7.07, p = 0.002) was higher in VD-deficient patients after adjusting for confounders. Vitamin D deficiency is frequent in patients with PBC and is associated with incomplete response to UDCA, cirrhosis development, and liver-related mortality or need for liver transplantation.

Keywords: chronic cholestasis; cirrhosis development; liver-related mortality; low vitamin D levels; treatment failure.

Figure 1

Cirrhosis-free survival in patients with and without vitamin D (VD) deficiency. Survival over time was assessed using Kaplan–Meier curves and the comparison between curves was performed using the log-rank test. Cirrhosis-free survival was shorter in patients with VD deficiency compared to the patients without deficiency (p < 0.001). Number of followed patients at each time-point is shown below the figure.

Figure 2

Liver-related event-free survival in patients with and without VD deficiency. Survival over time was assessed using Kaplan–Meier curves and the comparison between curves was performed using the log-rank test. Shorter liver-related event-free survival was noticed in VD-deficient patients compared to those without deficiency (p < 0.001). Number of followed patients at each time-point is shown below the figure.