Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients

Abstract

OBJECTIVES:Low levels of vitamin D are associated with a higher mortality in cirrhotic patients, but the role of this deficiency is still unknown. The purpose of this study was to assess the levels of vitamin D in cirrhotic patients with and without bacterial infection.METHODS:25-hydroxy (25-OH) vitamin D was assessed by immunoassay in 88 patients hospitalized in our hepatology unit.RESULTS:The causes of cirrhosis were mainly alcohol (70%), hepatitis C (10%), or both (9%). Infections (n=38) mainly included bacteriemia (21%), urinary tract infections (24%), and spontaneous bacterial peritonitis (29%). A severe deficiency in vitamin D (<10 ng/ml) was observed in 56.8% of patients. Infections were more frequent in patients with a severe deficiency compared with the others (54 vs. 29%, P=0.02). A severe deficiency in vitamin D was a predictive factor of infection (odds ratio=5.44 (1.35–21.97), P=0.017) independently of the Child–Pugh score (odds ratio=2.09 (1.47–2.97) P=0.00004) and the C-reactive protein level (odds ratio=1.03 (1.002–1.052), P=0.03) in a logistic regression also including the alanine amino transferase (not significant). By a Cox regression analysis, only the presence of an infection was significantly associated with mortality (relative risk=3.24 (1.20–8.76), P=0.02) in a model also associating the Child–Pugh score (not significant) and the presence of a severe deficiency in vitamin D (not significant).CONCLUSIONS:Low levels of 25-OH vitamin D were independently associated with bacterial infections in cirrhotic patients. The impact of 25-OH vitamin D supplementation on the infection rate and death of cirrhotic patients should be assessed in randomized trials.

Severe Vitamin D Deficiency May be an Additional Cofactor for the Occurrence of Alcoholic Steatohepatitis

“…A deleterious impact of the lack of vitamin D on the immune system is possible during severe chronic liver diseases (Iruzubieta et al, 2014). We have previously shown, in a cohort of mainly alcoholic cirrhotic patients, that a severe deficiency in 25-OH vitamin D was associated with an increased risk of bacterial infection independently of the Child-Pugh score (Anty et al, 2014).…”

Screening and Treatment of Vitamin D Deficiency on Hospital Admission: Is There a Benefit for Medical Inpatients?

“…Vitamin D insufficiency was not an independent risk factor for mortality in logistic regression analysis (OR= 1.8 95% CI 0.554-5.863, p = 0.328), thus Vitamin D insufficiency may be a helper but not a real risk factor for mortality Significant association between Vitamin D levels and illness severity on admission: SOFA Score: insufficiency: 8 (6-11), sufficiency: 6 (4-9), p = 0.005 APACHE II Score: insufficiency: 24 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) Multiple-regression model using variables that significantly correlated with admission FIM score (age, grip strength, and body weight): only serum 25OHD was a significant contributor (p = 0.02) to the multiple r value (multiple r = 0.42, p = 0.001).…”

“…23 The incidence of bacterial infections in cirrhotic patients has been found to not be associated with vitamin D levels. 22 Only one study looked at intensive care unit (ICU) admission rates and found a significant inverse relationship with vitamin D levels. 19 An investigation of a correlation between vitamin D levels and length of hospital stay showed contradicting results.…”

“…20 Four studies did not find a significant correlation between vitamin D deficiency and mortality. All studied a specific subgroup of medical inpatients: those with Clostridium difficile infections, 21 hepatic cirrhosis, 22 CAP, 23 or acute kidney injury. 24 …”

Enhanced LL‐37 expression following vitamin D supplementation in patients with cirrhosis and spontaneous bacterial peritonitis

“…It was found that a low level of vitamin D was independently associated with an increased risk of bacterial infection in patients with cirrhosis (10); however, the exact mechanism is unclear.…”