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Advanced liver cirrhosis death 6.3X more likely if extremely low vitamin D – Jan 2013

Association of extremely low vitamin D levels with increased mortality in patients with advanced

Congress Abstract
Z Gastroenterol 2013; 51 - P_3_10; DOI: 10.1055/s-0032-1332005
F Grünhage 1, M Krawczyk 1, C Stokes 1, M Langhirt 1, C Reichel 2, F Lammert 1
1 Saarland University Hospital, Medical Department II, Homburg, Germany
2 Rehabilitation Centre Bad Brückenau, Clinic Hartwald, Bad Brückenau, Germany

Aims: Patients with advanced liver disease frequently suffer from vitamin D deficiency. 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. 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: Sixty-one 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 vitamin D levels were determined in all patients using a chemiluminescence immunoassay. AUC analysis, Chi-square statistics and multivariate logistic regression analysis were used to determine the optimal cut-off for the discrimination of survivors from non-survivors. As we had shown previously sTNF-R75 serum levels were also associated with mortality in this cohort. Thus we also tested whether vitamin D levels in combination with higher sTNF-R55 or sTNF-R75 serum levels determine a higher risk of death.

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%).

No correlation of vitamin D levels with sTNF-R75 or sTNF-R55 levels was detected in our cohort. Furthermore we did not see a higher mortality of patients with higher sTNF-R and low vitamin D levels.

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 an impaired immune function due to vitamin D deficiency may explain this observation. Further studies in larger cohorts are warranted to replicate this finding.

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