Correlation between 25 hydroxyvitamin D level and liver cirrhosis of different etiologies

Abstract

Abstract: Objective To investigate the correlation between serum 25 hydroxyvitamin D [25(OH)D] level and cirrhosis.Methods Thirty patients with chronic hepatitis B (CHB) and 61 patients with liver cirrhosis of different etiologies (28 with hepatitis B-related liver cirrhosis, 5 with alcoholic liver cirrhosis, 11 with hepatitis C overlapping alcoholic liver cirrhosis, 17 with occult liver cirrhosis) were enrolled, including 28 patients in compensated stage and 33 patients in decompensated stage. All the patients were divided into 3 groups: CHB group, compensated liver cirrhosis group and decompensated liver cirrhosis group. The biochemical indexes of the 3 groups were analyzed and compared. The 25(OH)D level in cirrhosis of different etiologies was analyzed and compared. Pearson/Spearman correlation analysis was used to analyze the correlation between 25(OH)D levels and variables in cirrhosis. Binomial logistic regression analysis was used to evaluate the risk factors for 25(OH)D deficiency in cirrhosis. Results 1.There were significant differences in age, serum total bilirubin, serum alanine aminotransferase, serum albumin (ALB), serum creatinine, serum potassium, serum sodium, serum calcium and 25(OH)D among the 3 groups (P<0.05). The level of 25(OH)D in CHB group was higher than that in compensated cirrhosis and decompensated cirrhosis groups (25.22 ng/mL, 18.05 ng/mL, 15.46 ng/mL,P<0.01). 2.Among 61 cases of liver cirrhosis, 56 cases (91.8%) had 25(OH)D insufficiency/deficiency, including 28 (45.9%) in hepatitis B-related cirrhosis group, 5 (8.2%) in alcoholic cirrhosis group, 11 (18.0%) in mixed cirrhosis group, and 17 (27.9%) in occult cirrhosis group. And there was no significant difference in 25(OH)D level among 4 groups (P>0.05). 3. Pearson/Spearman correlation analysis showed that 25(OH)D was positively correlated with ALB (r=0.46, P<0.001) and blood potassium (r=0.34, P<0.01), but negatively correlated with international normalized ratio (r=-0.30, P<0.022). 4.Multivariate binomial logistic regression analysis showed that ALB was a risk factor for 25(OH)D deficiency in patients with liver cirrhosis (P<0.05).Conclusion Vitamin D insufficiency/deficiency is very common in patients with liver cirrhosis, and aggravate with the progress of liver disease, which has nothing to do with the etiology of liver cirrhosis. ALB is a risk factor for 25(OH)D deficiency in patients with liver cirrhosis.

Key words: Cirrhosis, 25 hydroxyvitamin D

HU Chen-bo, YAN Rong-mei, JIN Hong-hui, HUO Yong-kang, LI Zhong-ping. Correlation between 25 hydroxyvitamin D level and liver cirrhosis of different etiologies[J]. Chinese Hepatolgy, 2020, 25(5): 486-490.

References

[1] Ko BJ, Kim YS, Kim SG,et al.Relationship between 25-hydroxyvitamin D levels and liver fibrosis as assessed by transient elastography in patients with chronic liver disease.Gut Liver,2016,10:818-825.
[2] Duarte MP, Farias ML, Coelho HS, et al. Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease. J Gastroenterol Hepatol,2001,16:1022-1027.
[3] 中国中西医结合学会肝病专业委员会.肝纤维化中西医结合诊疗指南.中西医结合肝脏杂志,2006,16:316-320.
[4] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年版).中国肝脏病杂志(电子版),2015,7:1-18.
[5] Khan MA, Dar HA, Baba MA, et al.Impact of vitamin D status in chronic liver disease.J Clin Exp Hepatol,2019,9:574-580.
[6] Zhang Z, Thorne JL, Moore JB.Vitamin D and nonalcoholic fatty liver disease.Curr Opin Clin Nutr Metab Care,2019,22:449-458.
[7] Buonomo AR, Zappulo E, Scotto R, et al.Vitamin D deficiency is a risk factor for infections in patients affected by HCV-related liver cirrhosis.Int J Infect Dis,2017,63:23-29.
[8] Hoan NX, Khuyen N, Binh MT,et al.Association of vitamin D deficiency with hepatitis B virus-related liver diseases.BMC Infect Dis,2016, 16:507.
[9] Arteh J,Narra S,Nair S.Prevalence of vitamin D deficiency in chronic liver disease.Dig Dis Sci,2010,55:2624-2628.
[10] Zú?iga S, Firrincieli D, Housset C, et al. Vitamin D and the vitamin D receptor in liver pathophysiology. Clin Res Hepatol Gastroenterol,2011,35:295-302.
[11] Zhu L, Kong M, Han YP, et al.Spontaneous liver fibrosis induced by long term dietary vitamin D deficiency in adult mice is related to chronic inflammation and enhanced apoptosis.Can J Physiol Pharmacol,2015,93:385-394.
[12] Luger M, Kruschitz R, Kienbacher C,et al.Prevalence of liver fibrosis and its association with non-invasive fibrosis and metabolic markers in morbidly obese patients with vitamin D deficiency.Obes Surg,2016,26:2425-2432.
[13] Reiter F P,Hohenester S,Nagel J M,et al. 1,25-(OH)2-vitamin D-prevents activation of hepatic stellate cells in vitro and ameliorates inflammatory liver damage but not fibrosis in the Abcb4-/- model. Biochem Biophys Res Commun,2015,459:227-233.
[14] Abramovitch S,Dahan-Bachar L,Sharvit E,et al.Vitamin D inhibits proliferation and profibrotic marker expression in hepatic stellate cells and decreases thioacetamide -induced liver fibrosis in rats. Gut,2011,60:1728-1737.
[15] Potter JJ,Liu X,Koteish A,et al.1,25-dihydroxyvitamin D3 and its nuclear receptor repress human α1 (I) collagen expression and type I collagen formation. Liver Int ,2013, 33: 677-686.
[16] Kubesch A,Quenstedt L,Saleh M,et al.Vitamin D deficiency is associated with hepatic decompensation and inflammation in patients with liver cirrhosis: a prospective cohort study.PLoS One,2018,13:e0207162.
[17] Paternostro R,Wagner D,Reiberger T,et al.Low 25-OH-vitamin D levels reflect hepatic dysfunction and are associated with mortality in patients with liver cirrhosis.Wien Klin Wochenschr,2017,129:8-15.
[18] Kumar R, Kumar P, Saxena KN,et al.Vitamin D status in patients with cirrhosis of the liver and their relatives-A case control study from North India.Indian J Gastroenterol,2017,36:50-55.