Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis

Eur J Clin Invest. 2013 Nov 15. doi: 10.1111/eci.12205. [Epub ahead of print]

Stokes CS, Krawczyk M, Reichel C, Lammert F, Grünhage F.

Department of Medicine II, Saarland University Medical Center, Homburg, Germany.

Abstract

BACKGROUND: Chronic liver disease is the fifth most common cause of mortality in Europe. Recently, vitamin D deficiency has been associated with an increased risk of mortality in the general population. Since patients with advanced liver disease frequently exhibit vitamin D deficiency, we assessed for a possible association of vitamin D deficiency with survival in a cohort of patients with advanced liver disease.

METHODS:  Sixty-five patients with liver cirrhosis (median age, 58 years; range, 19-76 years; 66% male; Child-Pugh stage C, 46%) were included in our prospective single-center survival study. Serum 25-hydroxyvitamin D concentrations were measured by chemiluminescence immunoassay. The optimal cut-off was determined using area under the curve (AUC) and Kaplan-Meier analysis. Chi-square statistics and multivariate binary logistic regression analysis were also conducted.

RESULTS: Median serum vitamin D levels were 8.2 ng/ml (range < 4.0-95.8 ng/ml). Overall, 48% of patients (31/65) died during a 24-month follow-up period. AUC analysis determined a vitamin D level of 6.0 ng/ml as optimal cut-off for discriminating survivors from non-survivors. Kaplan-Meier analysis of survival confirmed low vitamin D levels as significant predictor of death (P = 0.012). Finally, multivariate analysis identified low vitamin D levels (OR = 6.3; 95% CI, 1.2-31.2; P = 0.012) and MELD scores (OR = 1.4; 95% CI, 1.2-1.7; P < 0.001) as independent predictors of survival.

CONCLUSION: Low vitamin D levels are associated with increased mortality in patients with advanced liver disease. Thus, serum levels of vitamin D might represent a critical marker of survival in advanced liver cirrhosis. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS: 25-hydroxyvitamin D, cholecalciferol, chronic liver disease, survival analysis

PMID: 24236541 [PubMed - as supplied by publisher]

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