Autoimmune Hepatitis 8X more likely if low vitamin D
Low Serum Vitamin D Levels Are Associated with Severe Histological Features and Poor Response to Therapy in Patients with Autoimmune Hepatitis - Dec 2014
Digestive Diseases and Sciences, December 2014, Volume 59, Issue 12, pp 3035-3042
Cumali Efe, Taylan Kav, Cisel Aydin, Mustafa Cengiz, Narin Nasıroglu Imga, Tugrul Purnak, Daniel S. Smyk, Murat Torgutalp, Turan Turhan, Seren Ozenirler
PDF is available free at Sci-Hub 10.1007/s10620-014-3267-3
Background and Aim
25-Hydroxyvitamin D [25(OH)D] has an important role in fibrosis progression and inflammatory response in patients with various etiologies of chronic liver disease. However, its influence on autoimmune hepatitis (AIH) has not been investigated. We evaluated the association of serum 25(OH)D levels with clinical, biochemical and histological features and response to therapy in AIH.
Materials and methods: Serum 25(OH)D levels were quantified in 68 therapy naïve AIH patients and 34 healthy controls.
Results
Mean serum 25(OH)D levels were significantly lower in AIH compared to healthy controls (16.8 ± 9.2 vs. 35.7 ± 13.6, p < 0.0001). Low levels of 25(OH)D (<30 µg/L) were independently associated with advance fibrosis and severe interface hepatitis in AIH patients [p = 0.014; odds ratio (OR) 0.12, 95 % confidence interval (CI) 0.02–0.65 and p = 0.020; OR 0.17, 95 % CI 0.04–0.76, respectively].
Severe 25(OH)D deficiency (<10 µg/L) was associated with
advance fibrosis,
severe interface hepatitis,
low platelet counts and
sampling time in a univariate analysis.
Only interface hepatitis and fibrosis scores were independently associated with 25(OH)D deficiency in a multiple regression analysis (p = 0.005; OR 0.12, 95 % CI 0.03–0.53 and p = 0.022; OR 0.15, 95 % CI 0.03–0.75, respectively).
Mean serum 25(OH)D levels were lower in non-responders compared to responders (9.2 ± 4.8 vs. 17.1 ± 9.4, p = 0.015), and 25(OH)D deficiency was more commonly observed in non-responders than the responders (80 vs. 43 %, p = 0.036).
Conclusions
Low 25(OH)D levels are associated with advance fibrosis and severe inflammation in AIH. Our study suggests that vitamin D may be a potential biomarker that predicts response to therapy and histological features in AIH.
References
Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006;354:54–66. CrossRef
Vergani D, Longhi MS, Bogdanos DP, et al. Autoimmune hepatitis. Semin Immunopathol. 2009;31:421–435. CrossRef
Efe C, Ozaslan E, Wahlin S, et al. Antibodies to soluble liver antigen in patients with various liver diseases: a multicentre study. Liver Int. 2013;33:190–196. CrossRef
Alvarez F, Berg PA, Bianchi FB, et al. International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–938. CrossRef
Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48:169–176. CrossRef
Manns MP, Czaja AJ, Gorham JD, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51:2193–2213. CrossRef
Liberal R, Longhi MS, Mieli-Vergani G, et al. Pathogenesis of autoimmune hepatitis. Best Pract Res Clin Gastroenterol. 2011;25:653–664. CrossRef
Smyk DS, Orfanidou T, Invernizzi P, et al. Vitamin D in autoimmune liver disease. Clin Res Hepatol Gastroenterol. 2013;37:535–545. CrossRef
Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis. 2007;66:1137–1142. CrossRef
Stokes CS, Volmer DA, Grunhage F, et al. Vitamin D in chronic liver disease. Liver Int. 2013;33:338–352. CrossRef
Stokes CS, Krawczyk M, Reichel C, et al. Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest. 2013. doi:10.1111/eci.12205.
Dasarathy J, Periyalwar P, Allampati S, et al. Hypovitaminosis D is associated with increased whole body fat mass and greater severity of non-alcoholic fatty liver disease. Liver Int. 2013. doi:10.1111/liv.12312.
Petta S, Camma C, Scazzone C, et al. Low vitamin D serum level is related to severe fibrosis and low responsiveness to interferon-based therapy in genotype 1 chronic hepatitis C. Hepatology. 2010;51:1158–1167. CrossRef
Farnik H, Bojunga J, Berger A, et al. Low vitamin D serum concentration is associated with high levels of hepatitis B virus replication in chronically infected patients. Hepatology. 2013;58:1270–1276. CrossRef
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–1930. CrossRef
Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996;24:289–293. CrossRef
Vogel A, Strassburg CP, Manns MP. Genetic association of vitamin D receptor polymorphisms with primary biliary cirrhosis and autoimmune hepatitis. Hepatology. 2002;35:126–131. CrossRef
Trépo E, Ouziel R, Pradat P, et al. Marked 25-hydroxyvitamin D deficiency is associated with poor prognosis in patients with alcoholic liver disease. J Hepatol. 2013;59:344–350. CrossRef
Ma Y, Longhi MS, Bogdanos DP, et al. 17 Functional impairment of CD25+CD4+ regulatory T cells characterizes autoimmune hepatitis type 2. Hepatology. 2003;38:163. CrossRef
Efe C, Purnak T, Ozaslan E. Anti TNF-alpha therapy can be a novel treatment option in patients with autoimmune hepatitis. Aliment Pharmacol Ther. 2010;32:115. CrossRef
Weiler-Normann C, Schramm C, Quaas A, et al. Infliximab as a rescue treatment in difficult-to-treat autoimmune hepatitis. J Hepatol. 2013;58:529–534. CrossRef
108 citations of Dec 2014 study as of Dec 2024
People with Autoimmune Hepatitis are 3.2X more likely to die if low Vitamin D – Dec 2024
Autoimmune Hepatitis and Vitamin D Deficiency: A Nationwide Perspective
Aliment Pharmacol Ther. 2024 Dec 11. doi: 10.1111/apt.18438 PDF behind paywall
Yassine Kilani 1, Saqr Alsakarneh 2, Mahmoud Y Madi 3, Daniel Alejandro Gonzalez Mosquera 1, Mariana Nunes Ferreira 1, Fouad Jaber 2, John Helzberg 4, Nikki Duong 5, Wing-Kin Syn 3 6
Background: Vitamin D deficiency is linked to worse outcomes in patients with chronic liver diseases (CLD). However, data in patients with autoimmune hepatitis (AIH) remain limited.
Aims: We aimed to assess the impact of vitamin D deficiency on the outcomes of individuals with AIH.
Methods: This retrospective cohort study used the TriNetX research network to identify patients with AIH. Patients were matched using propensity score matching and stratified to sufficient vitamin D levels (e.g., 25 (OH) D3 ≥ 30 ng/mL), vitamin D insufficiency (25 (OH) D3: 20-29.9 ng/mL) and vitamin D deficiency (e.g., 25 (OH) D3 < 20 ng/mL). The primary outcome was the all-cause mortality among adult patients with AIH. Secondary outcomes included decompensated liver cirrhosis, acute hepatic failure, liver transplantation (LT), all-cause hospitalizations and all-cause critical care admissions.
Results: A total of 1288 AIH patients with vitamin D deficiency were identified and propensity matched with 1288 patients with normal vitamin D levels.
Patients with vitamin D deficiency had significantly increased odds for
- all-cause mortality compared to those with normal levels (adjusted odds ratio (aOR) = 3.2, 95%CI: 2.3-4.48).
Patients with vitamin D deficiency were at increased odds of
all-cause hospitalizations (aOR = 2.37, 95%CI: 1.97-2.84),
critical care unit admissions (aOR = 2.8, 95%CI: 2.21-3.71),
decompensated liver cirrhosis (aOR = 2.74, 95%CI: 2.13-3.54),
acute hepatic failure (aOR = 3.11, 95%CI: 2.09-4.62) and
LT (aOR = 3.47, 95%CI: 1.71-7.04), as compared to those with normal vitamin D levels.
Conclusion: This cohort study showed significantly increased odds for all-cause mortality in AIH patients with vitamin D deficiency. Vitamin D deficiency in patients with AIH was associated with increased likelihood of hospitalisation, decompensated liver cirrhosis, acute liver failure and LT.
72 references online
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