Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis

BackgroundChronic liver disease is the fifth most common cause of mortality in Europe. 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. MethodsSixty-five patients with liver cirrhosis (median age, 58years; range, 19-76years; 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. ResultsMedian serum vitamin D levels were 82ng/mL (range<40-958ng/mL). Overall, 48% of patients (31/65) died during a 24-month follow-up period. ROC analysis determined a vitamin D level of 60ng/mL as optimal cut-off for discriminatingsurvivors from nonsurvivors. Kaplan-Meier analysis of survival confirmed low vitamin D levels as significant predictor of death (P=0012). Finally, multivariate analysis identified low vitamin D levels (OR=63; 95% CI, 12-312; P=0012) and MELD scores (OR=14; 95% CI, 12-17; P<0001) as independent predictors of survival. ConclusionLow 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.