J Korean Med Sci.  2020 Apr;35(19):e129. 10.3346/jkms.2020.35.e129.

Differential Impact of Serum 25-Hydroxyvitamin D3 Levels onthe Prognosis of Patients with LiverCirrhosis According to MELD andChild-Pugh Scores

Affiliations
  • 1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
  • 2Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
  • 3Department of Biostatistics, Korea University College of Medicine, Seoul, Korea

Abstract

Background
Prognosis of patients with diverse chronic diseases is reportedly associated with 25-hydroxyvitamin D levels. In this study, we investigated the potential role of 25-hydroxyvitamin D3 (25[OH]D3) levels in improving the predictive power of conventional prognostic models for patients with liver cirrhosis.
Methods
We investigated clinical findings, including serum 25(OH)D3 levels at admission, of 155 patients with cirrhosis who were followed up for a median of 16.9 months.
Results
Median 25(OH)D3 levels were significantly different among patients exhibiting Child-Pugh grades A, B, and C. Mortality, including urgent transplantation, was significantly associated with 25(OH)D3 levels in univariate analysis. Severe vitamin-D deficiency (serum 25[OH]D3 level < 5.0 ng/mL) was significantly related to increased mortality, even after adjusting for Child-Pugh and Model for End-stage Liver Disease (MELD) scores. In particular, the presence of severe vitamin D deficiency clearly defined a subgroup with significantly poorer survival among patients with Child-Pugh scores of 5–10 or MELD scores ≤ 20. A new combination model of MELD score and severe vitamin D deficiency showed significantly more accurate predictive power for short- and long-term mortality than MELD scores alone. Additionally, serum 25(OH)D3 levels and new model scores were significantly associated with the development of spontaneous bacterial peritonitis, overt encephalopathy, and acute kidney injury.
Conclusion
Serum 25(OH)D3 level is an independent prognostic factor for patients with liver cirrhosis and has a differential impact on disease outcomes according to MELD and Child-Pugh scores.

Keyword

Vitamin D; Cirrhosis; Prognosis; Complication
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