Serum 25-hydroxyvitamin D level in patients with chronic liver disease and its correlation with hepatic encephalopathy: A cross-sectional study

Priyadarshi Kumar; Sumita Chaudhry; Nishanth Dev; Rahul Kumar; Gaurav Singh

doi:10.4103/jfmpc.jfmpc_1084_19

Serum 25-hydroxyvitamin D level in patients with chronic liver disease and its correlation with hepatic encephalopathy: A cross-sectional study

J Family Med Prim Care. 2020 Feb 28;9(2):798-803. doi: 10.4103/jfmpc.jfmpc_1084_19. eCollection 2020 Feb.

Authors

Priyadarshi Kumar¹, Sumita Chaudhry¹, Nishanth Dev¹, Rahul Kumar¹, Gaurav Singh¹

Affiliation

¹ Department of Medicine, VMMC and Safdarjung Hospital, Delhi, India.

Abstract

Background: Hepatic encephalopathy (HE) is an established clinical manifestation in chronic liver disease (CLD). It is associated with various factors including gastrointestinal bleed, constipation, and dyselectrolemia. Recently 25-hydroxyvitamin D (25-OHD) deficiency has been identified as one of the factors associated with the development of HE. The current study was aimed to assess the level of 25-OHD in patients with CLD and hepatic encephalopathy and the relationship between 25-OHD deficiency and hepatic encephalopathy.

Materials and methods: This cross-sectional study included 100 subjects of either sex between 18 and 60 years of age, diagnosed as CLD on the basis of ultrasonography with hepatic encephalopathy and 50 age, sex-matched CLD subjects without encephalopathy. Hemogram, hepatic and renal functions, serum electrolytes, coagulation profile, and serum 25-hydroxyvitamin D levels were recorded.

Results: The baseline variables were matched for age, sex, hepatic and kidney function, and coagulation profiles. The hemoglobin (P = 0.002) and platelet count (P = 0.0003) were significantly lower in subjects with HE. The mean level of 25-OHD was significantly lower in subjects with HE as compared to the control group (25.62 ± 21.94 nmol/L vs 37.44 ± 18.61 nmol/L, P < 0.001). The mean 25-OHD level was 30.64 ± 21.64 nmol/L in grade 1 HE, 12.03 ± 11.05 nmol/L in grade 3 with P < 0.0001, and 18.8 ± 16.88 nmol/L in grade 4 with P < 0.0001 when compared to grade 1. Moderate and severe deficiency of 25-OHD level was significantly associated with higher grades of HE, i.e. grades 3 and 4 (P < 0.0001). There was a significant negative correlation between 25-OHD levels and worsening grades of hepatic encephalopathy (person's correlation coefficient r = -0.354; P = 0.0003).

Conclusion: In this cohort of North Indian population, serum 25-OHD level was significantly lower in patients with CLD and HE. The levels of 25-OHD showed a significant negative correlation with hepatic encephalopathy.

Keywords: Chronic liver disease; Vitamin D; encephalopathy.