Low 25-Hydroxyvitamin D Levels Are Associated with Infections and Mortality in Patients with Cirrhosis

Fabian Finkelmeier, Bernd Kronenberger, Stefan Zeuzem, Albrecht Piiper, Oliver Waidmann, Fabian Finkelmeier, Bernd Kronenberger, Stefan Zeuzem, Albrecht Piiper, Oliver Waidmann

Abstract

Background & aims: Vitamin D, best known to regulate bone mineralization, has numerous additional roles including regulation inflammatory pathways. Recently, an increased incidence of 25-hydroxyvitamin D3 (25(OH)D3) deficiency has been found in subjects suffering from liver diseases. We here investigated if low vitamin D levels might be associated with prognosis, inflammation and infectious complications in patients with cirrhosis.

Methods: We performed a prospective cohort study investigating the relation between 25(OH)D3 levels and stages of cirrhosis, mortality and complications of cirrhosis, including infections.

Results: 251 patients with cirrhosis were enrolled into the present prospective cohort study. 25(OH)D3 levels were quantified by radioimmunoassay from serum samples obtained at study inclusion. The mean follow-up time was 411 ± 397 days with a range of 1-1382 days. 30 (12.0%) patients underwent liver transplantation and 85 (33.8%) individuals died within the study. The mean serum 25(OH)D3 concentration was 8.93 ± 7.1 ng/ml with a range of 1.0 to 46.0 ng/ml. 25(OH)D3 levels differed significantly between Child Pugh scores and showed a negative correlation with the model of end stage liver disease (MELD) score. Patients with decompensated cirrhosis and infectious complications, had significantly lower 25(OH)D3 levels compared to subjects without complications. Low 25(OH)D3 was associated with mortality in uni- as well as multivariate Cox regression models.

Conclusions: 25(OH)D3 deficiency is associated with advanced liver disease and low 25(OH)D3 levels are an indicator for a poor outcome and are associated with infectious complications.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Association of Vitamin D levels…
Fig 1. Association of Vitamin D levels with etiologies and stages of cirrhosis.
Vitamin D levels in patients with and without alcoholic liver disease (1A). Serum 25(OH)D3 concentrations in stages of cirrhosis (1B) and its correlation with the MELD score (1C).
Fig 2. Relation of 25(OH)D 3 levels…
Fig 2. Relation of 25(OH)D3 levels and infections.
Serum Vitamin D levels in patients with and without infections (2A) and spontaneous bacterial peritonitis (2B). Relations of 25(OH)D3 concentrations and C-reactive protein (CRP) levels (2C) as well as soluble CD163 (sCD163) concentrations (2D) are shown.
Fig 3. Relation of Vitamin D concentrations…
Fig 3. Relation of Vitamin D concentrations and mortality.
The overall survival times of patients with the indicated Vitamin D levels are shown.

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