A Comparative Study of Vitamin D Levels in Non-Cholestatic Chronic Liver Disease and Healthy Controls

Author(s): Adil Aziz1 , Chaina Ram2 , Rohit Ishran3 , Ram Narayan Yadav4

BACKGROUND Chronic Liver Disease (CLD) is defined as the process of long-term progressive destruction and regeneration of the liver, and with advancing disease, hepatic fibrosis (scarring) and cirrhosis frequently occur. Given that liver is involved in bile salt production, absorption of vitamin D, and 25-hydroxylation of vitamin D, it might be expected that vitamin D deficiency would be common in patients with (CLD). METHODS The present hospital based observational comparative analysis was conducted in the Department of Medicine, and OPD (Out-Patient Department) and IPD (In Patient Department) of Gastroenterology, of SMS Hospital, Jaipur among a total of 60 participants. The study duration was of one year from 1st May 2016 to 30th April 2017. The minimum sample size required in each group was at 95% confidence interval and 80% power to verify the expected difference of 58.6% in proportion of cases with vitamin D deficiency in non-cholestatic chronic liver disease group with age and sex matched control group (hospital staff and attendants of patients) (76.5% vs. 17.96%) was 30 in each group. RESULTS 30 study participants were cases and 30 study participants were controls. Out of the total study participants 23 (38.3%) were female and 37 (61.7%) patients were male and the male to female sex ratio was 1.6 : 1. The mean age of 30 cases in our study was 39.1 ± 8.69 years and the mean age of 30 controls was 38.4 ± 8.02 years and no significant difference was observed. Mean serum Vitamin D3 was lower in CLD cases (23.4 ± 6.44 ng / L) as compared to controls (43.8 ± 5.18 ng / L). This difference was statistically significant with a p value <0.001. In univariate analysis in patients with non-cholestatic CLD, significant (P<0.05) positive correlations were found between serum level of vitamin D and serum bilirubin, serum albumin, platelet count, & haemoglobin. Also, there were significant (P<0.05) negative correlations between vitamin D concentration and serum bilirubin, INR & MELD score. No significant correlation was seen between vitamin D and age, serum level of PTH, calcium, phosphate, ALT, AST, ALP, urea, or creatinine. CONCLUSIONS Vitamin D inadequacy is very common in non-cholestatic CLD patients and correlates with the severity of the disease. Therefore, we recommend that clinical guidelines for managing non-cholestatic CLD should include the assessment of vitamin D status in all patients. For vitamin D assessment and replacement in the management of patients with non-cholestatic CLD further studies are required.