Extremely low vitamin D levels are associated with increased mortality in patients with liver cirrhosis

F Grünhage; M Mahler; M Krawczyk; C Stokes; C Reichel; F Lammert

doi:10.1055/s-0032-1324006

Zeitschrift für Gastroenterologie, Table of Contents

Extremely low vitamin D levels are associated with increased mortality in patients with liver cirrhosis

F Grünhage ¹, M Mahler ¹, M Krawczyk ¹, C Stokes ¹, C Reichel ², F Lammert ¹

¹Saarland University Medical Center, Medical Department II, Homburg, Germany
²Rehabilitation Center Bad Brückenau, Clinic Hartwald, German Pension Insurance, Federal Office, Bad Brückenau, Germany

Abstract

Aims: Vitamin D serves an important role in regulating immune response mechanisms, and vitamin D deficiency has been associated with unfavourable outcomes in patients infected with chronic hepatitis C. Patients with advanced liver disease frequently suffer from vitamin D deficiency. However, it remains unknown whether vitamin D deficiency has an influence on mortality in these patients. Thus, we prospectively studied a cohort of patients with advanced liver disease to assess the influence of vitamin D deficiency on survival.

Patients and methods: Ninety-two patients with liver cirrhosis (mean age, 55 years; range, 19–76 years; 66% males; CTP stage C, 41%) were included in our prospective single-center survival study. Serum for determination of vitamin D status was available from 61 patients. AUC analysis, Chi-square statistics and multivariate binary regression analysis were used to determine the optimal cut-off. Vitamin D levels were determined using a chemiluminescence immunoassay.

Results: Median vitamin D levels were 8.2ng/ml (range <4ng/ml –95.8ng/ml) Overall, 51% of patients (31/61) died during a minimal follow-up of 24 months. AUC analysis determined a vitamin D level of 6ng/ml as optimal cut-off for discriminating survivors from non-survivors. Kaplan-Meier analysis of survival confirmed low vitamin D levels as a significant predictor of death (p=0.004).

Of note, multivariate analysis identified low vitamin D levels (OR=6.3; CI: 1.2–31.2; p=0.024) and MELD scores (OR=1.4; CI: 1.2–1.7; p<0.001) as independent predictors of survival. Patients with low vitamin D levels died more often from septic complications (43%) than patients with vitamin D levels >6ng/ml (20%).

Conclusion: Extremely low serum levels of vitamin D levels are associated with increased mortality in patients with advanced liver disease. Infectious complications are more frequent in these patients. We speculate that a impaired immune function due to vitamin D deficiency may explain this observation. Further studies in larger cohorts are warranted to replicate this finding.