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. 2018 Jun 28;6(2):135-140.
doi: 10.14218/JCTH.2017.00055. Epub 2018 Feb 1.

Vitamin D Deficiency and Its Relationship with Child-Pugh Class in Patients with Chronic Liver Disease

Zubia Jamil  1 , Sharmin Arif  1 , Anum Khan  1 , Asghar Aurangzeb Durrani  2 , Nayyar Yaqoob  2
Affiliations

Vitamin D Deficiency and Its Relationship with Child-Pugh Class in Patients with Chronic Liver Disease

Zubia Jamil et al. J Clin Transl Hepatol. .

Abstract

Background and Aims: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their relationship with disease advancement in these patients. Methods: Vitamin D levels were checked in 125 chronic liver disease patients. The patients were classified in three stages according to Child-Pugh score: A, B and C. The relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency coefficient. Correlation and logistic regression analyses were also carried out to find additional predictors of low vitamin D levels. Results: Among the patients, 88% had either insufficient or deficient stores of vitamin D, while only 12% had sufficient vitamin D levels (p >0.05). Vitamin D levels were notably related to Child-Pugh class (contingency coefficient = 0.5, p <0.05). On univariate and multinomial regression analyses, age, female sex, MELD and Child-Pugh class were predictors of low vitamin D levels. Age, model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels (p <0.05). Conclusions: Vitamin D deficiency is notably related to age, female sex and model of end-stage liver disease score, in addition to Child-Pugh class of liver cirrhosis. Vitamin D levels should be routinely checked in patients with advanced liver cirrhosis (Child-Pugh class B and C) and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.

Keywords: Liver cirrhosis; Liver disease; Osteodystrophy; Skeletal manifestations; Vitamin D deficiency.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1.
Fig. 1.. Patients with chronic liver disease and controls according to vitamin D categories.
The X-axis shows the three categories of vitamin D levels: deficiency (<20 ng/mL), insufficiency (20–30 ng/mL) and sufficiency (>30 ng/mL). The Y-axis shows the frequency of patients and controls according to the three categories of vitamin D. The majority of cirrhotic patients (52.8%, n = 66; controls: 27%) had insufficient vitamin D levels. Vitamin D deficiency was found in 34.4% (n = 43; controls: 26%). Sufficient levels of vitamin D were found in only 12.8% (n = 16; controls: 47%) of patients with liver cirrhosis.
Fig. 2.
Fig. 2.. Vitamin D levels in Child-Pugh class A, B and C for patients with chronic liver disease.
Vitamin D levels were much lower in class C, as compared to classes A and B. Vitamin D levels gradually decreased from class A to class C, meaning that as the disease advances the levels decrease further.
See this image and copyright information in PMC

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