Vitamin D deficiency is associated with hepatic decompensation and inflammation in patients with liver cirrhosis: A prospective cohort study

Abstract

BackgroundVitamin D is required to maintain the integrity of the intestinal barrier and inhibits inflammatory signaling pathways.ObjectiveVitamin D deficiency might be involved in cirrhosis-associated systemic inflammation and risk of hepatic decompensation in patients with liver cirrhosis.MethodsOutpatients of the Hepatology Unit of the University Hospital Frankfurt with advanced liver fibrosis and cirrhosis were prospectively enrolled. 25-hydroxyvitamin D (25(OH)D3) serum concentrations were quantified and associated with markers of systemic inflammation / intestinal bacterial translocation and hepatic decompensation.ResultsA total of 338 patients with advanced liver fibrosis or cirrhosis were included. Of those, 51 patients (15%) were hospitalized due to hepatic decompensation during follow-up. Overall, 72 patients (21%) had severe vitamin D deficiency. However, patients receiving vitamin D supplements had significantly higher 25(OH)D3 serum levels compared to patients without supplements (37 ng/mL vs. 16 ng/ml, P<0.0001). Uni- and multivariate analyses revealed an independent association of severe vitamin D deficiency with the risk of hepatic decompensation during follow-up (multivariate P = 0.012; OR = 3.25, 95% CI = 1.30–8.2), together with MELD score, low hemoglobin concentration, low coffee consumption, and presence of diabetes. Of note, serum levels of C-reactive protein, IL-6 and soluble CD14 were significantly higher in patients with versus without severe vitamin D deficiency, and serum levels of soluble CD14 levels declined in patients with de novo supplementation of vitamin D (median 2.15 vs. 1.87 ng/mL, P = 0.002).ConclusionsIn this prospective cohort study, baseline vitamin D levels were inversely associated with liver-cirrhosis related systemic inflammation and the risk of hepatic decompensation.

Acute Hepatic Failure and Nutrition

“…Whether vitamin D deficiency is regularly observed in patients with ALF is unknown. Vitamin D deficiency has been noted in patients with advanced liver fibrosis and cirrhosis . In this study, serum levels of inflammatory markers such as C‐reactive protein, interleukin‐6, and soluble CD14 were significantly higher in patients with vs those without severe vitamin D deficiency.…”

“…In this study, serum levels of inflammatory markers such as C‐reactive protein, interleukin‐6, and soluble CD14 were significantly higher in patients with vs those without severe vitamin D deficiency. Furthermore, serum levels of soluble CD14 levels declined in patients with de novo supplementation of vitamin D . It may be beneficial to patients to supplement vitamin D if levels are low.…”

Effects of Vitamin D Supplementation and Seasonality on Circulating Cytokines in Adolescents: Analysis of Data From a Feasibility Trial in Mongolia

“…The increased IL-6 observed in the supplemented children is consistent with IL-6 up-regulation in the peripheral blood mononuclear cells of vitamin D supplemented multiple sclerosis patients (24). At the same time vitamin D deficiency was associated with high IL-6 (25) and vitamin D supplementation down-regulated IL-6 in some studies (26–29). These seemingly contradictory findings regarding IL-6 and vitamin D could be attributed to various confounders and differences among the studies, such as the duration and dosage of vitamin D supplementation, the participants' genetic background, underlying clinical conditions, effects of clinical therapy, and extent of vitamin D insufficiency/deficiency at baseline.…”

Pancreatic Cancer (PDAC): Introduction of Evidence-Based Complementary Measures into Integrative Clinical Management

“…Indirectly, by promoting the synthesis and binding of insulin (thereby decreasing insulin resistance and the risk of diabetes), vitamin D may also reduce the risk of PDAC [ 220 , 222 ]. Finally, a relationship between vitamin D deficiency and increased inflammation has also been suggested, but not confirmed [ 223 ]. It has even been highlighted that the daily recommended dietary allowance for vitamin D could be increased [ 224 ].…”