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Differential Impact of Serum 25-Hydroxyvitamin D3 Levels on the Prognosis of Patients with Liver Cirrhosis According to MELD and Child-Pugh Scores

Journal of Korean Medical Science 2020년 35권 19호 p.129 ~ 129
김태현 ( Kim Tae-Hyung ) - Korea University College of Medicine Department of Internal Medicine

 ( Yun Seung-Gyu ) - Korea University College of Medicine Department of Laboratory Medicine
최지미 ( Choi Ji-Mi ) - Korea University college of Medicine Department of Biostatistics
 ( Goh Hyun-Gil ) - Korea University College of Medicine Department of Internal Medicine
이한아 ( Lee Han-Ah ) - Korea University College of Medicine Department of Internal Medicine
임선영 ( Yim Sun-Young ) - Korea University College of Medicine Department of Internal Medicine
최성지 ( Choi Seong-Ji ) - Korea University College of Medicine Department of Internal Medicine
이영선 ( Lee Young-Sun ) - Korea University College of Medicine Department of Internal Medicine
 ( Yoon Eileen L. ) - Korea University College of Medicine Department of Internal Medicine
정영걸 ( Jung Young-Kul ) - Korea University College of Medicine Department of Internal Medicine
서연석 ( Seo Yeon-Seok ) - Korea University College of Medicine Department of Internal Medicine
김지훈 ( Kim Ji-Hoon ) - Korea University College of Medicine Department of Internal Medicine
임형준 ( Yim Hyung-Joon ) - Korea University College of Medicine Department of Internal Medicine
연종은 ( Yeon Jong-Eun ) - Korea University College of Medicine Department of Internal Medicine
변관수 ( Byun Kwan-Soo ) - Korea University College of Medicine Department of Internal Medicine
엄순호 ( Um Soon-Ho ) - Korea University College of Medicine Department of Internal Medicine

Abstract


Background: Prognosis of patients with diverse chronic diseases is reportedly associated with 25-hydroxyvitamin D levels. In this study, we investigated the potential role of 25-hydroxyvitamin D3 (25[OH]D3) levels in improving the predictive power of conventional prognostic models for patients with liver cirrhosis.

Methods: We investigated clinical findings, including serum 25(OH)D3 levels at admission, of 155 patients with cirrhosis who were followed up for a median of 16.9 months.

Results: Median 25(OH)D3 levels were significantly different among patients exhibiting Child-Pugh grades A, B, and C. Mortality, including urgent transplantation, was significantly associated with 25(OH)D3 levels in univariate analysis. Severe vitamin-D deficiency (serum 25[OH]D3 level < 5.0 ng/mL) was significantly related to increased mortality, even after adjusting for Child-Pugh and Model for End-stage Liver Disease (MELD) scores. In particular, the presence of severe vitamin D deficiency clearly defined a subgroup with significantly poorer survival among patients with Child-Pugh scores of 5?10 or MELD scores ≤ 20. A new combination model of MELD score and severe vitamin D deficiency showed significantly more accurate predictive power for short- and long-term mortality than MELD scores alone. Additionally, serum 25(OH)D3 levels and new model scores were significantly associated with the development of spontaneous bacterial peritonitis, overt encephalopathy, and acute kidney injury.

Conclusion: Serum 25(OH)D3 level is an independent prognostic factor for patients with liver cirrhosis and has a differential impact on disease outcomes according to MELD and Child-Pugh scores.

키워드

Vitamin D; Cirrhosis; Prognosis; Complication
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