High prevalence of Vitamin D deficiency in patients with autoimmune Hepatitis: impact on clinical presentation and response to treatment

S Beinhardt; M Eder; R Marculescu; R Strassl; A Stättermayer; J Stift; K Kozbial; C Freissmuth

doi:10.1055/s-0035-1551749

Zeitschrift für Gastroenterologie, Table of Contents

High prevalence of Vitamin D deficiency in patients with autoimmune Hepatitis: impact on clinical presentation and response to treatment

S Beinhardt ¹, M Eder ¹, R Marculescu ², R Strassl ³, A Stättermayer ¹, J Stift ⁴, K Kozbial ¹, C Freissmuth ¹

¹Medizinische Universität Wien; Innere Medizin III, Gastroenterologie und Hepatologie, Wien, Austria
²Department of Medical and Chemical and Laboratory Diagnostics; Medical University of Vienna, Vienna, Austria
³Department of Virology, Medical University of Vienna, Wien, Austria
⁴Medizinische Universität Wien; Clinical Institute of Pathology, Wien, Austria

Abstract

Background & Aims: Besides its role in calcium-homeostasis, vitamin D has shown to exert pleiotropic actions in patients with liver disease including immune-modulatory properties, which are of particular interest in autoimmune hepatitis (AIH). We analyzed the presence of vitamin D-deficiency and its association with laboratory, histological and clinical presentation in patients with AIH, as well as the response to immuno-suppressive treatment.

Patients & Methods: Ninety six consecutive AIH-patients (m/f: 30/66; age: 40.9 ± 18.4 years[8 – 76]; mean ± SD [range]; AIH type-1 (N = 80/83.3%)) were retrospectively analyzed; 25-(OH)-Vitamin-D3 levels were determined prior to treatment. Diagnosis of AIH was based on the simplified and/or revised scoring system of the IAIHG.

Results: 25-(OH)-D3-levels were below the limit of normal (< 75 nmol/l) in 83/86.5% AIH-patients (39.9 ± 18.1 [< 10 – 73.0] nmol/l, mean ± SD [range]); vitamin D-deficiency, defined as 25-(OH)-D3 levels below 50 nmol/l was found in 58/60.4% patients (30.9 ± 12.1[10 x ULN) at diagnosis compared to patients with ALT< 10 x ULN (53.2 ± 28.1 vs. 40.7 ± 21.5 nmol/l [mean ± SD]; P = 0.16). Pretreatment vitamin-D levels did not influence response to immuno-suppressive treatment, defined as normalization of transaminases at 6 and 12 months after therapy-initiation, respectively.

Conclusion: Low levels of vitamin D are common in patients with AIH. Although vitamin D levels do not seem to influence clinical presentation or response to treatment, our findings underscore the need of vitamin D supplementation in patients with AIH, undergoing steroid based immunosuppressive treatment.