Researchers from Germany recently found that low vitamin D status is an indicator for poor prognosis in patients with cirrhosis, and was associated with infectious complications.
Cirrhosis is a disease of the liver in which the healthy liver tissue is replaced with scar tissue, causing the liver to eventually become dysfunctional. The disease slowly progresses, often occurring in two stages, compensated and decompensated. In the first stage, the liver still functions normally or possesses the ability to compensate for the damage. In the second stage, the liver can no longer function properly, and therefore is referred to as the decompensated stage. Patients with decompensated cirrhosis have nearly a ten-fold increased risk of death compared to the general population.
High inflammation is associated with unfavorable prognosis in patients with cirrhosis. Since low vitamin D levels are inversely related to inflammation, researchers predicted that vitamin D is linked to prognosis in patients with cirrhosis. While small studies have proven this hypothesis true, large prospective studies have yet to investigate.
Recently, researchers enrolled 251 patients with cirrhosis into a study with an average follow-up of 411 days, or 1.13 years. The researchers wanted to explore the relationship between vitamin D status and prognosis of cirrhosis, or more specifically the stages of cirrhosis, mortality and complications.
The researchers measured vitamin D levels at baseline. Levels less than 10 ng/ml were considered as severe vitamin D deficiency; levels from 10 to 20 ng/ml were considered as insufficiency and serum levels greater than 20 ng/ml were considered as sufficiency.
Commonly used predictors of prognosis for cirrhosis patients are the Child-Pugh-Score and the model for end stage liver disease (MELD). MELD measures the disease activity in patients with cirrhosis, with a high score indicating high disease activity. The Child-Pugh score also assesses prognosis. The assessment is scored with a letter ranging from A to C, with C indicating the worst prognosis.
The researchers compared the patients’ vitamin D status to MELD and Child-Pugh scores, mortality and complications. Here is what they found:
- The average vitamin D status was 8.9 ng/ml among the patients with cirrhosis.
- Eighty five patients died within the study.
- Lowest vitamin D levels were significantly associated with Child C patients (p < 0.001).
- There was a significant inverse relationship between vitamin D levels and the MELD score (p < 0.001).
- Patients suffering from infections at baseline had significantly lower vitamin D levels compared to individuals without infections (p < 0.001).
- Vitamin D levels lesser than or equal to 6 ng/ml were associated with higher mortality compared to higher vitamin D levels (p = 0.013). However, vitamin D levels less than 10 ng/ml were not significantly associated with higher mortality (p = 0.555).
- Patients with decompensated cirrhosis had significantly lower vitamin D levels compared to patients without complications (p < 0.001).
The researchers concluded,
“In the present study, we showed that serum 25(OH)D3 correlated with the severity of liver insufficiency and were associated with infectious complications.”
“Furthermore, very low serum 25(OH)D3 concentrations were an independent risk factor for mortality in patients with cirrhosis…”
Randomized controlled trials need to be conducted to understand the effects of vitamin D supplementation on outcomes in patients with cirrhosis.