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Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis
Author(s) -
Stokes Caroline S.,
Krawczyk Marcin,
Reichel Christoph,
Lammert Frank,
Grünhage Frank
Publication year - 2014
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12205
Subject(s) - medicine , gastroenterology , liver disease , cirrhosis , vitamin d deficiency , prospective cohort study , vitamin d and neurology , survival analysis , population , logistic regression , environmental health
Background Chronic liver disease is the fifth most common cause of mortality in E urope. Recently, vitamin D deficiency has been associated with an increased risk of mortality in the general population. As patients with advanced liver disease frequently exhibit vitamin D deficiency, we assessed for a possible association of vitamin D deficiency with survival in a cohort of patients with advanced liver disease. Methods Sixty‐five patients with liver cirrhosis (median age, 58 years; range, 19–76 years; 66% male; Child‐Pugh stage C, 46%) were included in our prospective single‐centre survival study. Serum 25‐hydroxyvitamin D concentrations were measured by chemiluminescence immunoassay. The optimal cut‐off was determined using receiver operating characteristic (ROC) and Kaplan‐Meier analysis. Chi‐square statistics and multivariate binary logistic regression analysis were also conducted. Results Median serum vitamin D levels were 8·2 ng/mL (range <4·0–95·8 ng/mL). Overall, 48% of patients (31/65) died during a 24‐month follow‐up period. ROC analysis determined a vitamin D level of 6·0 ng/mL as optimal cut‐off for discriminating survivors from nonsurvivors. Kaplan–Meier analysis of survival confirmed low vitamin D levels as significant predictor of death ( P = 0·012). Finally, multivariate analysis identified low vitamin D levels ( OR = 6·3; 95% CI , 1·2–31·2; P = 0·012) and MELD scores ( OR = 1·4; 95% CI , 1·2–1·7; P < 0·001) as independent predictors of survival. Conclusion Low vitamin D levels are associated with increased mortality in patients with advanced liver disease. Thus, serum levels of vitamin D might represent a critical marker of survival in advanced liver cirrhosis.