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Severe vitamin D deficiency prognostic of outcomes in autoimmune hepatitis

16 Jan 2019

Severe vitamin D deficiency occurs commonly in patients with autoimmune hepatitis (AIH) and is associated with treatment nonresponse, progression to cirrhosis, and liver-related death or need for liver transplantation, a study has found.

Researchers looked at 209 patients (mean age 42 years; 75 percent female; mean body mass index, 30 kg/m2) who underwent liver tissue examination at presentation. Of the patients, 58 percent had AIH, and the mean MELD score at diagnosis was 17. The mean serum vitamin D level at baseline was 60 nmol/L, with 42 patients (20 percent) considered severely deficient (serum levels <25 nmol/L).

Relative to patients without severe vitamin D deficiency, those who had the condition were significantly more likely to show nonresponse to treatment (59 percent vs 41 percent; p=0.04). Nonresponse was defined as non‐normalised aspartate aminotransferase/alanine aminotransferase and immunoglobulin G levels during conventional immunosuppressive therapy.

On Cox proportional hazards analysis, severe vitamin D deficiency was also independently associated with a greater risk of developing cirrhosis (hazard ratio [HR], 3.40; 95 percent CI, 1.30–8.87; p=0.01) and of liver‐related mortality or requirement for liver transplantation (HR, 5.26; 1.54–18.0; p=0.008).

Of note, patients with persistent severe vitamin D even after vitamin D supplementation continued to have poor outcomes.

The present data suggest that serum vitamin D level may be a useful prognostic biomarker in AIH, and routine measurement of the levels should be considered at presentation, researchers said. Empiric vitamin D supplementation is a clinical decision that can be justified by low serum levels and the risk of glucocorticoid‐induced bone disease.

Meanwhile, the effect of vitamin D supplementation on the state of being deficient may also reflect the hepatic response to glucocorticoid therapy and signify restoration of vitamin D metabolism and homoeostatic functions, they added.

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Most Read Articles
Stephen Padilla, 13 Feb 2019
The Mandarin-speaking population in Singapore (SG) has deemed the translated Chronic Liver Disease Questionnaire (CLDQ) culturally acceptable, with only two items that needed revision in the finalized CLDQ-SG, according to a recent study.
Rachel Soon, 30 Sep 2016

Understanding the factors which induce visceral hypersensitivity (VH) in patients with functional gastrointestinal disorders (FGIDs) may help doctors manage patients and develop new treatments, says an expert.

Dr. Angela V. Ignacio, 21 Feb 2017
Administration of a probiotic appears to be a safe and effective therapeutic alternative for minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis, according to a Greek study presented at the 26th Conference of the Asian Pacific Association for the Study of the Liver (APASL) held in Shanghai, China.