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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Serum 25-hydroxyvitamin D deficiency and hepatic encephalopathy in chronic liver disease
Helen Vidot, Alison Potter, Robert Cheng, Margaret Allman-Farinelli, Nicholas Shackel
Helen Vidot, Department Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia
Helen Vidot, Alison Potter, Robert Cheng, Centenary Institute, University of Sydney, Sydney NSW 2006, Australia
Alison Potter, Robert Cheng, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia
Margaret Allman-Farinelli, School of Life and Environmental Sciences, University of Sydney, Sydney NSW 2006 Australia
Nicholas Shackel, Faculty of Medicine, University of Sydney, Sydney NSW 2006, Australia
Nicholas Shackel, South Western Sydney Clinical School, University of New South Wales, New South Wales NSW 2052, Australia
Author contributions: Vidot H and Shackel N contributed to the study concept and design; Vidot H and Potter A contributed equally to the study design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content and statistical analysis; Vidot H drafted the manuscript; Potter A contributed to the revision of the manuscript; Shackel N and Allman-Farinelli M contributed to the revision of the manuscript, technical supervision and the study supervision; Cheng R contributed to the statistical analysis of the manuscript.
Institutional review board statement: The study has approved by the Ethics Review Committee (RPAH Zone).
Informed consent statement: Informed consent was not necessary due to the retrospective nature of this investigation.
Conflict-of-interest statement: There were no conflicts of interests for any of the investigators.
Data sharing statement: Technical appendix, statistical code and dataset are available from the corresponding author at helen.vidot@sswahs.nsw.gov.au. Informed consent was not sought as all data was collected as part of standard care and all data is anonymised and risk of identification is low. No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Helen Vidot, BSc, Department Nutrition and Dietetics, Royal Prince Alfred Hospital, Building 12, Missenden Road, Camperdown NSW 2050, Australia. helen.vidot@sswahs.nsw.gov.au
Telephone: +61-2-95156111
Received: October 26, 2016
Peer-review started: October 28, 2016
First decision: November 22, 2016
Revised: February 5, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: April 8, 2017
AIM
To investigate the relationship between 25-hydroxyvitamin D (25-OHD) deficiency and hepatic encephalopathy (HE) in patients with chronic liver disease (CLD).
METHODS
A retrospective analysis of the results of 392 adult patients with chronic liver disease who were assessed for liver transplantation between 2006 and 2010 was undertaken. HE, severity of CLD, nutritional status and 25-OHD were analysed in patients assessed for liver transplantation between 2006 and 2010. Patients who presented with acute, fulminant or subacute disease, with a primary diagnosis of liver cancer, were assessed for re-transplantation or who did not have a 25-OHD measurement were excluded from the analysis.
RESULTS
One hundred and sixty-five patients were included in this analysis. The mean age of all patients was 53 ± 8 years. Moderate to severe 25-OHD deficiency was identified in 49 patients of whom 36 had grade 2-3 HE compared with 13 patients who were not encephalopathic (P ≤ 0.0001). Mild 25-OHD deficiency was not associated with HE. There was a significant correlation between the severity of 25-OHD deficiency and the severity of liver disease (r = 0.39, P ≤ 0.0001) and disease severity and the presence of HE (P ≤ 0.0001). Importantly, individuals with 25-OHD deficiency were more likely to have a diagnosis of overt HE (OHE) at a significantly lower model for end stage liver disease (MELD) score than individuals without OHE (P ≤ 0.0001). This significant difference was observed with MELD scores from 10 to 38.
CONCLUSION
25-OHD deficiency was observed in the majority of patients with CLD and for the first time was found to be significantly worse in patients with OHE.
Core tip: A strong association between vitamin D deficiency and deteriorating liver disease is identified in this investigation which supports previous reported findings. The novel finding in this investigation is the relationship between vitamin D deficiency and overt hepatic encephalopathy (OHE) in patients with chronic liver disease (CLD) which is independent of renal impairment and nutritional status. As repeated episodes of OHE may result in some residual neuropsychiatric alterations, maintenance of vitamin D levels within normal range in patients with CLD should be considered in clinical management. These results provide a strong rationale for future intervention studies in this group.
