The Concentration Of 25-Hydroxy Vitamin D In Chronic Liver Disease And Its Correlation With Severity

Abstract

Background: Chronic liver disease (CLD is a common disease all over the world and the major cliological factors for the causation of disease are HBV and HCV in this country and Alcoholic liver disease in the western world. With the availability of the modern treatment, the life expectancy is increased now a days. But the long term complications are now evident. One of the complications is hepatic osteodystrophy which is associated with deficiency of vitamin D. Vitamin D undergoes hepatic 25-hydroxylation, but as the hepatic parenchyma is jeopardized so the metabolic activation of this vitamin is impaired. Vitamin D deficiency is highly prevalent in CLD patients and vitamin D level is inversely related to the severity of the disease. Objective: To assess the concentration of 25-hydroxy vitamin D in chronic liver disease patient in different etiology and to study the relationship of level of 25(OH) D in different stages of the disease according to Child-Pugh classification. Methods: This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of April 2015 to March 2016. Patient attending the Gastroenterology Department who fulfill the inclusion criteria with cirrhosis of liver were initially be enrolled for the study. Their clinical history, examination and initial investigation report were noted in the standard data sheet. After explaining the study objective, informed consent was taken. The diagnosis of liver cirrhosis was made by combination of clinical features, blood profile and transabdominal ultrasound. Endoscopy of the upper GIT was done to see the presence of oesophageal or gastric varices which is a sign of increase portal pressure. Transabdominal ultrasound demonstrated a shrunken liver with increase echogenicity, with or without splenomegally and presence or absence of ascites. Stages of liver disease were assessed by Child-Pugh scoring system. Level of 25(OH) D was measured from blood with the permission of the Department of Bio-chemistry. Data was collected using a structered data sheet. Results: Out of 85 patients, male were 61 (71.8%) and female were 24 (28.2%). Mean age was 53.0 ± 10.7 years within tin- range of 25-70 years. More than 90.0% patient* had abates and anorexia. Eighty percent patients had weight loss and 71.8% patients had Jaundice. More than 40.0% patients had abdominal pain and melaena. Sixty (77.9%) patients had history of blood transfusion and 73 (94.8%) patients had previous hospitalization, Most of the patients had anaemia (97.6%) and Splenomegaly (92.9%). More than 50.0% patients had jaundice (61.2%), Leukonychia (61.2%) and hone pain (52.9%). Mean s, vitamin 25(OH) D was 16.29 ± 7.96 in 69 HBV patients and 20.14 ± 9.76 in 16 HCV patients. In this study, 28.2% patients were in child Pugh A, 36.4% in child Pugh B and 32.9% in child Pugh C stages. Mean s. vitamin 25(OH) D were 27.12 ± 6.11, 15.97 ± 5.40 and 9.57 ± J.I5 in Child-pugh A, Child-pugh B and Child-pugh C stages respectively. Mean s. vitamin 25(OH) D was gradually decreased as the changes of stage from lower to higher. Conclusion: Vitamin D deficiency is highly prevalent in patients with CLD and inversely correlated with disease severity. In the case of chronic liver diseases, vitamin D seems to modulate the innate and adaptive immune system, which explains the association. In fact, clinical studies suggest that these parameters may improve with vitamin D supplementation. So, monitoring of S. 25(OH) D is reasonable in CLD patient.