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Low 25-Hydroxyvitamin D Levels Are Associated with Infections and Mortality in Patients with Cirrhosis.

Finkelmeier F, Kronenberger B, Zeuzem S, Piiper A, Waidmann O - PLoS ONE (2015)

Bottom Line: Recently, an increased incidence of 25-hydroxyvitamin D3 (25(OH)D3) deficiency has been found in subjects suffering from liver diseases.Patients with decompensated cirrhosis and infectious complications, had significantly lower 25(OH)D3 levels compared to subjects without complications.Low 25(OH)D3 was associated with mortality in uni- as well as multivariate Cox regression models. 25(OH)D3 deficiency is associated with advanced liver disease and low 25(OH)D3 levels are an indicator for a poor outcome and are associated with infectious complications.

View Article: PubMed Central - PubMed

Affiliation: Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.

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)D3) 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)D3 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)D3 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)D3 concentration was 8.93 ± 7.1 ng/ml with a range of 1.0 to 46.0 ng/ml. 25(OH)D3 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)D3 levels compared to subjects without complications. Low 25(OH)D3 was associated with mortality in uni- as well as multivariate Cox regression models.

Conclusions: 25(OH)D3 deficiency is associated with advanced liver disease and low 25(OH)D3 levels are an indicator for a poor outcome and are associated with infectious complications.

No MeSH data available.


Related in: MedlinePlus

Relation of Vitamin D concentrations and mortality.The overall survival times of patients with the indicated Vitamin D levels are shown.
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pone.0132119.g003: Relation of Vitamin D concentrations and mortality.The overall survival times of patients with the indicated Vitamin D levels are shown.

Mentions: As patients with advanced cirrhosis had lower serum 25(OH)D3 concentrations, we hypothesized that 25(OH)D3 levels might be of prognostic value in these patients. Recently, serum 25(OH)D3 concentrations of 6 ng/ml or 10 ng/ml indicating 25(OH)D3 deficiency have been proposed to be of prognostic value in cirrhotic individuals with or without HCC, respectively [14,15,19]. 25(OH)D3 levels ≤ 6 ng/ml were associated with higher mortality compared to higher 25(OH)D3 levels in the present cohort (HR 1.723, 95% CI 1.122–2.646, P = 0.013 for 6 ng/ml). However, serum 25(OH)D3 concentrations ≤ 10 ng/ml were not significantly associated with higher mortality HR 1.424, 95% CI 0.889–2.279, P = 0.141 for 10 ng/ml) (Fig 3). Several patients received vitamin D substitution. Therefore, the impact of vitamin D alimentation was investigated. Substitution with vitamin D was not significantly associated with overall survival (HR 0.841, 95% CI 0.473–1.494, P = 0.555).


Low 25-Hydroxyvitamin D Levels Are Associated with Infections and Mortality in Patients with Cirrhosis.

Finkelmeier F, Kronenberger B, Zeuzem S, Piiper A, Waidmann O - PLoS ONE (2015)

Relation of Vitamin D concentrations and mortality.The overall survival times of patients with the indicated Vitamin D levels are shown.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4487892&req=5

pone.0132119.g003: Relation of Vitamin D concentrations and mortality.The overall survival times of patients with the indicated Vitamin D levels are shown.
Mentions: As patients with advanced cirrhosis had lower serum 25(OH)D3 concentrations, we hypothesized that 25(OH)D3 levels might be of prognostic value in these patients. Recently, serum 25(OH)D3 concentrations of 6 ng/ml or 10 ng/ml indicating 25(OH)D3 deficiency have been proposed to be of prognostic value in cirrhotic individuals with or without HCC, respectively [14,15,19]. 25(OH)D3 levels ≤ 6 ng/ml were associated with higher mortality compared to higher 25(OH)D3 levels in the present cohort (HR 1.723, 95% CI 1.122–2.646, P = 0.013 for 6 ng/ml). However, serum 25(OH)D3 concentrations ≤ 10 ng/ml were not significantly associated with higher mortality HR 1.424, 95% CI 0.889–2.279, P = 0.141 for 10 ng/ml) (Fig 3). Several patients received vitamin D substitution. Therefore, the impact of vitamin D alimentation was investigated. Substitution with vitamin D was not significantly associated with overall survival (HR 0.841, 95% CI 0.473–1.494, P = 0.555).

Bottom Line: Recently, an increased incidence of 25-hydroxyvitamin D3 (25(OH)D3) deficiency has been found in subjects suffering from liver diseases.Patients with decompensated cirrhosis and infectious complications, had significantly lower 25(OH)D3 levels compared to subjects without complications.Low 25(OH)D3 was associated with mortality in uni- as well as multivariate Cox regression models. 25(OH)D3 deficiency is associated with advanced liver disease and low 25(OH)D3 levels are an indicator for a poor outcome and are associated with infectious complications.

View Article: PubMed Central - PubMed

Affiliation: Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.

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)D3) 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)D3 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)D3 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)D3 concentration was 8.93 ± 7.1 ng/ml with a range of 1.0 to 46.0 ng/ml. 25(OH)D3 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)D3 levels compared to subjects without complications. Low 25(OH)D3 was associated with mortality in uni- as well as multivariate Cox regression models.

Conclusions: 25(OH)D3 deficiency is associated with advanced liver disease and low 25(OH)D3 levels are an indicator for a poor outcome and are associated with infectious complications.

No MeSH data available.


Related in: MedlinePlus