Estimation of Vitamin D Level in Patients of Chronic Liver Disease and its Association with Child Turcotte Pugh’s Score
Vitamin D Level in Patients of Chronic Liver Disease
Background: Chronic liver disease (CLD) has a fairly high occurrence in the Indian subcontinent due to variety of etiological factors including alcohol abuse, viral hepatitis, etc. As liver plays a crucial role in digestive as well as metabolic functions, its significant dysfunction is related to severe imbalance of vitamin D. Though for long the role of vitamin D in bone mineral metabolism is known yet recent literature has suggested its significant role in immune modulation, inflammatory response and in fibrosis. Since insufficient data on vitamin D levels in CLD patients exists in Indian population, hence we planned this study. Subjects and Methods: Hundred patients of CLD were included in our study following approval from institutional ethics committee, obtaining informed written consent and excluding bone disease, chronic renal disease, known cardiac disease & known malignancy. All patients underwent estimation of vitamin D levels and appropriate tests to diagnose CLD with further categorization into A, B, C as per Child-Turcot-Pugh (CP) Criteria. Appropriate statistical tests were then applied to find out the association between CLD and vitamin D levels. Results: Majority of the CLD patients were males and in 3rd-5thdecade with most of them i.e. 89% in our study, had insufficiency or deficiency of vitamin D in their serum with majority having moderate to severe grades of CLD as per CP score. This association was statistically significant with p value of less than <0.01. Also, a negative Pearson correlation was observed meaning thereby that as the CP score increases, the vitamin D levels decrease. Conclusion: Since vitamin D plays a key role in immune based responses, its serum level is crucial in patients suffering with chronic liver diseases, where the serum vitamin D levels decrease as the Child-Turcot-Pugh score of liver disease increases. Early recognition of insufficient or deficient levels of serum vitamin D by their simple & inexpensive serum estimation may go a long way in not only instituting early therapy but also in preventing related morbidities.
2. Blachier M, Leleu H, Peck-Radosavljevicm, Valla DC, Roudot- Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593– 608. Available from: https://doi.org/10.1016/j.jhep.2012.12. 005.
3. Setiawan VW, Stram DO, Porcel J, Lu SC, Marchand LL, Noureddin M. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort. Hepatology. 2016;64(6):1969–1977. Available from: https://dx.doi.org/10.1002/hep.28677.
4. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies. J Hepatol. 2006;44(1):217–231. Available from: https://dx.doi.org/10.1016/j.jhep.2005.10.013.
5. Rode A, Fourlanos S, Nicoll A. Oral vitamin D replacement is effective in chronic liver disease. Gastroenterol Clin Biol. 2010;34(11):618–620. Available from: https://dx.doi.org/10. 1016/j.gcb.2010.07.009.
6. Meena VK. A study on epidemiology and clinical profile of acute on Chronic Liver Disease in hospitalized patients. Jaipur, India; 2015.
7. ; 2017. Available from: http://www.nlfindia.com. Lastaccessedon21.
8. ; 2017. Available from: http://www.worldlifeexpectancy.com.
9. ; 2011. Available from: http://www.dnaindia.com/ health/report-fata-record-one-death-a-day-due-to- liverdisease1725416.Lastaccessedon23.
10. Vieira PM, De-Souza DA, Oliveira LC. Nutritional assessment in hepatic cirrhosis;clinical, anthropometric, biochemical and hematological parameters. Nutr Hosp. 2013;28(5):1615–1621. Available from: https://doi.org/10.3305/nh.2013.28.5.6563.
11. Konstantakis C. Vitamin D deficiency in patients with liver cirrhosis. Ann Gastroenterol. 2016;29:297–306. Available from: https://dx.doi.org/10.20524/aog.2016.0037.
12. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80(6):1689. Available from: https://dx.doi.org/10.1093/ajcn/80.6.1689s.
13. Heaney RP. The Vitamin D requirement in health and disease. J Steroid Biochem Mol Biol. 2005;97(1-2):13–19. Available from: https://dx.doi.org/10.1016/j.jsbmb.2005.06.020.
14. Vanoirbeek E, Krishnan A, Eelen G, Verlinden L, Bouillon R, Feldman D, et al. The anti-cancer and anti-inflammatory actions of 1,25(OH)2D3. Best Pract Res Clin Endocrinol Metab. 2011;25(4):593–604. Available from: https://dx.doi. org/10.1016/j.beem.2011.05.001.
15. Rosen JC. Vitamin D insufficiency NEJM. 2011;364:248–254.
16. Kitson MT, Roberts SK. D-livering the message: the importance of vitamin D status in chronic liver disease. J Hepatol. 2012;57(4):897–909. Available from: https://doi.org/ 10.1016/j.jhep.2012.04.033.
17. Arteh J, Narra S, Nair S. Prevalence of Vitamin D Deficiency in Chronic Liver Disease. Dig Dis Sci. 2010;55(9):2624–2628. Available from: https://dx.doi.org/10.1007/s10620-009-1069- 9.
18. Stokes CS, Volmer DA, Grünhage F, Lammert F. Vitamin D in chronic liver disease. Liver Int. 2013;33(3):338–352. Available from: https://dx.doi.org/10.1111/liv.12106.
19. Czaja MJ, Weiner FR, Flanders KC, Giambrone MA, Wind R, Biempica L, et al. In vitro and in vivo association of transforming growth factor-beta 1 with hepatic fibrosis. J Cell Biol. 1989;108(6):2477–2482. Available from: https://dx.doi. org/10.1083/jcb.108.6.2477.
20. Tan X, Li Y, Liu Y. Therapeutic role and potential mechanisms of active Vitamin D in renal interstitial fibrosis. J Steroid Biochem Mol Biol. 2007;103:491–496. Available from: https://doi.org/10.1016/j.jsbmb.2006.11.011.
21. Zhang Z, Sun L, Wang Y. Renoprotective roleof the vitamin D receptor in diabetic nephropathy. Kidney Int. 2008;73:163–
171. Available from: https://doi.org/10.1038/sj.ki.5002572.
22. Holick MF. Vitamin D Deficiency. N Engl J Med. 2007;357(3):266–281. Available from: https://dx.doi.org/10. 1056/nejmra070553.
23. Bonkovsky HL, Hawkins M, Steinberg K, Hersh T, Galambos JT, Henderson JM, et al. Prevalence and prediction of osteope- nia in chronic liver disease. Hepatology. 1990;12(2):273–280. Available from: https://dx.doi.org/10.1002/hep.1840120214.
24. Fisher L, Fisher A. Vitamin D and Parathyroid Hormone in Outpatients With Noncholestatic Chronic Liver Disease. Clin Gastroenterol Hepatol. 2007;5(4):513–520. Available from: https://dx.doi.org/10.1016/j.cgh.2006.10.015.
25. Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic
review and meta-analysis of observational studies. Medicine (Baltimore). 2016;95:2877. Available from: https://doi.org/10. 1097/md.0000000000002877.
26. Kang W, Kim SU, Ahn SH. Non-invasive prediction of forth- coming cirrhosisrelatedcomplications. World J Gastroenterol. 2014;20:2613–2623. Available from: https://dx.doi.org/10. 3748/wjg.v20.i10.2613.
27. Kennel KA, Drake MT, Hurley DL. Vitamin D Deficiency
in Adults: When to Test and How to Treat. Mayo Clin Proc. 2010;85(8):752–758. Available from: https://dx.doi.org/10. 4065/mcp.2010.0138.
28. Kumar R, Kumar P, Saxena KN, Mishra M. Vitamin D status in patients with cirrhosis of the liver and their relatives-A case control study from North India. Indian J Gastroenterol. 2017;36(1):50–55. Available from: https://doi.org/10.1007/ s12664-017-0727-7.
29. Jamil Z, Arif S, Khan A, Durrani AA, Yaqoob N. Vitamin D Deficiency and Its Relationship with Child-Pugh Class in Patients with Chronic Liver Disease. J Clin Transl Hepatol
. 2018;6(2):1–6. Available from: https://dx.doi.org/10.14218/ jcth.2017.00055.
30. Khan MA, Dar HA, Baba MA, Shah AH, Singh B, Shiekh NA. Impact of Vitamin D Status in Chronic Liver Disease. J Clin Exp Hepatol. 2019;9(5):574–580. Available from: https://dx.doi.org/10.1016/j.jceh.2019.03.001.
31. Zhao XY, Li J, Wang JH. Vitamin D serum level is associated with Child-Pugh score and metabolic enzyme imbalances, but not viral load in chronic hepatitis B patients. Medicine (Baltimore). 2016;95:3926. Available from: https://doi.org/10. 1097/md.0000000000003926.
32. Fernández NF, Torres PL, Matias DJ, Plaza FJ, Goñi JLO. Vitamin D deficiency in chronic liver disease, clinical- epidemiological analysis and report after vitamin d supplemen- tation. Gastroenterol Hepatol. 2016;39:305–310. Available from: https://doi.org/10.1016/j.gastrohep.2015.10.003.
Copyright (c) 2021 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.