Low 25-hydroxyvitamin D levels are associated with infections and mortality in patients with cirrhosis

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)D 3) 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)D 3 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)D 3 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)D 3 concentration was 8.93 ± 7.1 ng/ml with a range of 1.0 to 46.0 ng/ml. 25(OH)D 3 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)D 3 levels compared to subjects without complications. Low 25(OH)D 3 was associated with mortality in uni- as well as multivariate Cox regression models. Conclusions: 25(OH)D 3 deficiency is associated with advanced liver disease and low 25(OH)D 3 levels are an indicator for a poor outcome and are associated with infectious complications.