Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
Eur J Clin Invest. 2014 Feb;44(2):176-83. doi: 10.1111/eci.12205. Epub 2013 Dec 9.
Chronic liver disease is the fifth most common cause of mortality in Europe. Recently, vitamin D deficiency has been associated with an increased risk of mortality in the general population. As patients with advanced liver disease frequently exhibit vitamin D deficiency, we assessed for a possible association of vitamin D deficiency with survival in a cohort of patients with advanced liver disease.
Sixty-five patients with liver cirrhosis (median age, 58 years; range, 19-76 years; 66% male; Child-Pugh stage C, 46%) were included in our prospective single-centre survival study. Serum 25-hydroxyvitamin D concentrations were measured by chemiluminescence immunoassay. The optimal cut-off was determined using receiver operating characteristic (ROC) and Kaplan-Meier analysis. Chi-square statistics and multivariate binary logistic regression analysis were also conducted.
Median serum vitamin D levels were 8·2 ng/mL (range <4·0-95·8 ng/mL). Overall, 48% of patients (31/65) died during a 24-month follow-up period. ROC analysis determined a vitamin D level of 6·0 ng/mL as optimal cut-off for discriminating survivors from nonsurvivors. Kaplan-Meier analysis of survival confirmed low vitamin D levels as significant predictor of death (P = 0·012). Finally, multivariate analysis identified low vitamin D levels (OR = 6·3; 95% CI, 1·2-31·2; P = 0·012) and MELD scores (OR = 1·4; 95% CI, 1·2-1·7; P < 0·001) as independent predictors of survival.
Low vitamin D levels are associated with increased mortality in patients with advanced liver disease. Thus, serum levels of vitamin D might represent a critical marker of survival in advanced liver cirrhosis.
慢性肝脏疾病是欧洲第五大致死原因。最近，维生素 D 缺乏与一般人群的死亡率增加有关。由于晚期肝病患者经常出现维生素 D 缺乏，我们评估了晚期肝病患者维生素 D 缺乏与生存的可能关联。
我们纳入了一项前瞻性单中心生存研究中的 65 例肝硬化患者（中位年龄 58 岁；范围 19-76 岁；66%为男性；Child-Pugh 分级 C 级，46%）。使用化学发光免疫分析法测定血清 25-羟维生素 D 浓度。使用受试者工作特征（ROC）和 Kaplan-Meier 分析确定最佳截断值。还进行了卡方检验和多变量二元逻辑回归分析。
中位血清维生素 D 水平为 8.2ng/mL（范围 <4.0-95.8ng/mL）。在 24 个月的随访期间，共有 48%的患者（31/65）死亡。ROC 分析确定维生素 D 水平 6.0ng/mL 为区分存活者和非存活者的最佳截断值。Kaplan-Meier 分析生存情况证实，低维生素 D 水平是死亡的显著预测因子（P=0.012）。最后，多变量分析确定低维生素 D 水平（OR=6.3；95%CI，1.2-31.2；P=0.012）和 MELD 评分（OR=1.4；95%CI，1.2-1.7；P<0.001）是生存的独立预测因子。
低维生素 D 水平与晚期肝病患者的死亡率增加相关。因此，血清维生素 D 水平可能是晚期肝硬化患者生存的关键标志物。
