Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Aug 15, 2017; 8(3): 133-141
Published online Aug 15, 2017. doi: 10.4291/wjgp.v8.i3.133
Effect of replenishment of vitamin D on survival in patients with decompensated liver cirrhosis: A prospective study
Ashish Kumar Jha, Sharad Kumar Jha, Amarendra Kumar, Vishwa Mohan Dayal, Sanjeev Kumar Jha
Ashish Kumar Jha, Sharad Kumar Jha, Amarendra Kumar, Vishwa Mohan Dayal, Sanjeev Kumar Jha, Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna 800014, India
Author contributions: Jha AK drafted the manuscript, oversight of the study, assisted with data analysis and prepared the manuscript; Jha SK recruited the patients, involved with data collection and performed statistical analysis; Dayal VM participated in design and oversight of the study; Kumar A participated in design of the study and oversight of the study, Jha SK was involved with data collection, and assisted with data analysis; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrolment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data 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: Ashish Kumar Jha, MD, DM, Assistant Professor, Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna 800014, India. ashishjhabn@yahoo.co.in
Telephone: +91-612-2297631 Fax: +91-612-2297225
Received: November 13, 2016
Peer-review started: November 15, 2016
First decision: December 20, 2016
Revised: May 1, 2017
Accepted: June 6, 2017
Article in press: June 8, 2017
Published online: August 15, 2017
Abstract
AIM

To assess the vitamin D (VD) deficiency as a prognostic factor and effect of replenishment of VD on mortality in decompensated cirrhosis.

METHODS

Patients with decompensated liver cirrhosis were screened for serum VD levels. A total of 101 VD deficient patients (< 20 ng/mL) were randomly enrolled in two groups: Treatment group (n = 51) and control group (n = 50). Treatment group received VD treatment in the form of intramuscular cholecalciferol 300000 IU as loading dose and 800 IU/d oral as maintenance dose along with 1000 mg oral calcium supplementation. The VD level, clinical parameters and survival of both the groups were compared for 6-mo.

RESULTS

Prevalence of vitamin D deficiency (VDD) in decompensated CLD was 84.31%. The mean (SD) age of the patients in the treatment group (M:F: 40:11) and control group (M:F: 37:13) were 46.2 (± 14.93) years and 43.28 (± 12.53) years, respectively. Baseline mean (CI) VD (ng/mL) in control group and treatment group were 9.15 (8.35-9.94) and 9.65 (8.63-10.7), respectively. Mean (CI) serum VD level (ng/mL) at 6-mo in control group and treatment group were 9.02 (6.88-11.17) and 29 (23-35), respectively. Over the period of time the VD, calcium and phosphorus level was improved in treatment group compared to control group. There was non-significant trend seen in greater survival (69% vs 64%; P > 0.05) and longer survival (155 d vs 141 d; P > 0.05) in treatment group compared to control group. VD level had no significant association with mortality (P > 0.05). In multivariate analysis, treatment with VD supplement was found significantly (P < 0.05; adjusted hazard ratio: 0.48) associated with survival of the patients over 6-mo.

CONCLUSION

VD deficiency is very common in patients of decompensated CLD. Replenishment of VD may improve survival in patients with decompensated liver cirrhosis.

Keywords: Chronic liver diseases, Vitamin D, Vitamin D deficiency, Decompensated liver cirrhosis, Survival

Core tip: This was a prospective study to assess the vitamin D (VD) deficiency as a prognostic factor for survival in patients with decompensated chronic liver diseases (n = 101) and effect of replenishment of VD on all-cause mortality in decompensated liver cirrhosis. Treatment with VD supplement was found associated with survival of the patients over 6-mo. Replenishment of VD along with calcium supplementation may improve survival in patients with decompensated cirrhosis. These findings need to be confirmed in larger multicenter studies.