Prospective evaluation of associations between Vitamin D levels and hepatic decompensation and systemic inflammation in patients with liver cirrhosis

Question:

Vitamin D is involved in the integrity of the intestinal barrier and in anti-inflammatory signaling pathways. The aim of the presented prosprective study was to investigate whether differences in serum Vitamin D levels in patients with liver cirrhosis have an impact on the risk of hepatic decompensation.

Methods:

Outpatients of the Hepatology Unit of the University Hospital Frankfurt with advanced liver fibrosis and cirrhosis were prospectively enrolled and followed up every three months and when admitted with hepatic decompensation. Vitamin D levels, clinical and laboratory variables, and markers of systemic inflammation and intestinal bacterial translocation were measured. Associations with hepatic decompensation were assessed in logistic regression models.

Results:

A total of 338 patients with advanced liver fibrosis or cirrhosis of different etiologies (34% HCV, 15% HBV, 30% alcoholic, 10% NASH, 11% other) were included in this study. The median vitamin D serum concentration in the entire cohort was 23 ng/mL. Vitamin D serum levels differed remarkably between patients who took supplements (n = 118) and patients not taking vitamin D supplements (36.5 ng/mL versus 16 ng/mL, respectively), but not according to the MELD score or liver stiffness. For 54 out of 338 patients, hospitalization due to hepatic decompensation (progressive ascites, hepatorenal syndrome, hepatic encephalopathy, gastrointestinal bleeding, infections) was required during follow-up. Baseline vitamin D levels in patients with or without hepatic decompensation were 13 ng/mL vs. 25 ng/mL, respectively (P = 0.0004). Moreover, there was an inverse correlation between vitamin D serum levels and markers of bacterial translocation/systemic inflammation CRP, IL-6, I-FABP, soluble CD14 and bacterial DNA (P

Conclusions:

In this prospective cohort study, baseline vitamin D levels were inversely association with markers of bacterial translocation/systemic inflammation and the risk of hepatic decompensation.