Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan.
Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan; Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan.
Clin Nutr ESPEN. 2024 Oct;63:267-273. doi: 10.1016/j.clnesp.2024.06.055. Epub 2024 Jul 2.
BACKGROUNDS & AIMS: This study aimed to investigate the association between vitamin D deficiency and covert hepatic encephalopathy (CHE), overt hepatic encephalopathy (OHE) occurrence, and mortality in patients with cirrhosis.
This retrospective study reviewed 679 patients with cirrhosis. Vitamin D deficiency was defined as serum 25-hydorxyvitamin D (25-OHD) levels < 20 ng/mL. The associations between 25-OHD and CHE, OHE occurrence, and mortality were assessed using logistic regression, Fine-Gray competing risk regression, and Cox proportional hazards regression models, respectively.
Of 428 eligible patients, 75% had vitamin D deficiency and 23% had CHE. The prevalence of CHE was higher in patients with vitamin D deficiency than in those without vitamin D deficiency (28% vs. 13%, p = 0.002). During the median follow-up period of 2.3 years, 14% of the patients developed OHE and 27% died. Patients with vitamin D deficiency had a higher incidence of OHE (p = 0.002) and mortality (p = 0.006) than those without vitamin D deficiency. After adjustment for potential covariates, multivariate analyses showed that 25-OHE was associated with CHE (odds ratio, 0.95; 95% confidence interval [CI], 0.91-0.99; p = 0.023), OHE occurrence (sub-distribution hazard ratio, 0.92; 95% CI, 0.86-0.98; p = 0.013) and mortality (hazard ratio, 0.96; 95% CI, 0.93-0.99; p = 0.020) in patients with cirrhosis.
Vitamin D deficiency is highly prevalent and is associated with CHE, OHE, and mortality in patients with cirrhosis. Evaluation of vitamin D is essential to predict the outcomes of patients with cirrhosis.
本研究旨在探讨维生素 D 缺乏与肝硬化患者隐匿性肝性脑病（CHE）、显性肝性脑病（OHE）发生及死亡的关系。
本回顾性研究纳入了 679 例肝硬化患者。维生素 D 缺乏定义为血清 25-羟维生素 D（25-OHD）水平＜20ng/mL。采用逻辑回归、Fine-Gray 竞争风险回归和 Cox 比例风险回归模型评估 25-OHD 与 CHE、OHE 发生及死亡率之间的关系。
在 428 例符合条件的患者中，75%存在维生素 D 缺乏，23%存在 CHE。维生素 D 缺乏患者 CHE 的患病率高于无维生素 D 缺乏患者（28%比 13%，p=0.002）。在中位 2.3 年的随访期间，14%的患者发生 OHE，27%的患者死亡。维生素 D 缺乏患者 OHE 发生率（p=0.002）和死亡率（p=0.006）均高于无维生素 D 缺乏患者。调整潜在混杂因素后，多变量分析显示，25-OHD 与 CHE（优势比，0.95；95%置信区间[CI]，0.91-0.99；p=0.023）、OHE 发生（亚分布风险比，0.92；95% CI，0.86-0.98；p=0.013）和死亡率（风险比，0.96；95% CI，0.93-0.99；p=0.020）相关。
维生素 D 缺乏在肝硬化患者中很常见，与 CHE、OHE 和死亡率相关。评估维生素 D 对预测肝硬化患者的结局至关重要。
