Severe vitamin D deficiency prognostic of outcomes in autoimmune hepatitis
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.