Effect of replenishment of vitamin D on survival in patients with decompensated liver cirrhosis: A prospective study

Abstract

AIMTo assess the vitamin D (VD) deficiency as a prognostic factor and effect of replenishment of VD on mortality in decompensated cirrhosis.METHODSPatients with decompensated liver cirrhosis were screened for serum VD levels. A total of 101 VD deficient patients (< 20 ng/mL) were randomly enrolled in two groups: Treatment group (n = 51) and control group (n = 50). Treatment group received VD treatment in the form of intramuscular cholecalciferol 300000 IU as loading dose and 800 IU/d oral as maintenance dose along with 1000 mg oral calcium supplementation. The VD level, clinical parameters and survival of both the groups were compared for 6-mo.RESULTSPrevalence of vitamin D deficiency (VDD) in decompensated CLD was 84.31%. The mean (SD) age of the patients in the treatment group (M:F: 40:11) and control group (M:F: 37:13) were 46.2 (± 14.93) years and 43.28 (± 12.53) years, respectively. Baseline mean (CI) VD (ng/mL) in control group and treatment group were 9.15 (8.35-9.94) and 9.65 (8.63-10.7), respectively. Mean (CI) serum VD level (ng/mL) at 6-mo in control group and treatment group were 9.02 (6.88-11.17) and 29 (23-35), respectively. Over the period of time the VD, calcium and phosphorus level was improved in treatment group compared to control group. There was non-significant trend seen in greater survival (69% vs 64%; P > 0.05) and longer survival (155 d vs 141 d; P > 0.05) in treatment group compared to control group. VD level had no significant association with mortality (P > 0.05). In multivariate analysis, treatment with VD supplement was found significantly (P < 0.05; adjusted hazard ratio: 0.48) associated with survival of the patients over 6-mo.CONCLUSIONVD deficiency is very common in patients of decompensated CLD. Replenishment of VD may improve survival in patients with decompensated liver cirrhosis.

Nutritional issues in patients with obesity and cirrhosis

“…Findings are also conflicting with regard to the effect of vitamin D supplementation in the case of advanced liver disease. In a cohort of advanced decompensated cirrhotic patients (Child-Pugh C, score of ≥ 10) randomly assigned to vitamin D treatment or a control receiving standard care and followed for 6 mo, the survival, as well as Child-Pugh and MELD scores, were comparable between the groups[ 48 ]. Nevertheless, supplementation of high-dose oral vitamin D resulted in several clinical improvements such as an anti-depressant effect among patients with chronic liver disease (mainly women)[ 78 ], and 60% risk reduction for acute rejection among patients after LT[ 79 ].…”

A narrative review of nutritional abnormalities, complications, and optimization in the cirrhotic patient

“…For example, zinc supplementation was noted to reduce the impact of HE (specifically owed to its facilitation of the urea cycle) and the incidence of hepatocellular carcinoma (31). Vitamin D supplementation can help to increase the survival odds of cirrhotic patients and augment the immune response in cases of spontaneous bacterial peritonitis (60). Magnesium repletion has been demonstrated to slow disease progression, exert hepatoprotective qualities, and even limit hepatitis C virus (HCV) replication (15).…”

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

“…In fact, there was a higher incidence of overt HE in patients with low levels of 25‐OHD at similar levels of disease severity . It has been shown that vitamin D replenishment may improve survival in patients with decompensated liver cirrhosis possibly by improving the defense against viral and bacterial pathogens . Thus, vitamin D supplementation has been suggested in cirrhotic patients with serum levels of 25(OH) vitamin D < 30 ng/mL, through administration of 5000 IU/d vitamin D 3 or 50,000 IU/wk vitamin D 2 or D 3 for 3 months followed by indefinite administration of 1000 IU/d .…”