May 3, 2013

Vitamin D deficiency linked to portal hypertension complications, poor prognosis among cirrhotic patients

May 3, 2013

Patients with alcoholic cirrhosis and severe vitamin D deficiency are at a greater risk for death and more likely to have severe cirrhosis and experience portal hypertension-related complications, according to data presented at the International Liver Congress in Amsterdam.

Researchers evaluated serum levels of 25-hydroxyvitamin D (25OHD) in 254 patients (mean age, 54.8 years) with alcoholic cirrhosis (AC). Ninety-one percent of patients also underwent hepatic venous pressure gradient (HVPG) measurement. Disease severity was assessed for each case, along with incidence of complications related to portal hypertension and mortality after 1 year. Median follow-up was 5 months.

The cohort had a median vitamin D level of 8.8 ng/mL. Sixty-three percent of patients had a BMI greater than 25 kg/m2, and 77% drank more than 80 g of alcohol daily. Alcoholic hepatitis was observed in 23% of cases. Among evaluated participants, the mean HVPG was 16.6 ± 6 mmHg.

Severe 25OHD deficiency, defined as levels below 10 ng/mL, was associated with elevated HVPG (P<.001), MELD and Child-Turcotte-Pugh scores (P<.001 for each) and increased frequency of alcoholic hepatitis (P=.001). Ascites (P<.001), encephalopathy (P=.001), hepatorenal syndrome (P<.001) and spontaneous bacterial peritonitis (P=.033) also were significantly more common among those with severe 25OHD deficiency. Bleeding occurred more frequently among vitamin D-deficient patients, but was not significant (22.8% of cases vs. 16.1%; P=.152).

After adjustment for age, sex, BMI greater than 25 kg/m2 and MELD score, 25OHD levels below 10 ng/mL were significantly associated with increased 1-year mortality risk (HR=4.33; 95% CI, 1.47-12.78).

“Severe vitamin D deficiency is associated with higher cirrhosis severity, most complications of portal hypertension and early mortality in AC patients,” the researchers concluded. “Vitamin D may well represent both a biomarker of severity and prognosis in AC. These results may also advocate for vitamin D supplementation in AC.”

For more information:

Trépo E. #120: Severe Vitamin D Deficiency Is Associated with Complications of Portal Hypertension and a Worse Prognosis in Alcoholic Cirrhosis. Presented at: The International Liver Congress 2013; April 24-28, Amsterdam.