Relationship between vitamin D deficiency and the development of hepatic encephalopathy among patients with liver cirrhosis

Abstract

To evaluate the vitamin D status of patients with liver cirrhosis and to determine the role of serum vitamin D level, if any, in the development of hepatic encephalopathy (HE). This cross-sectional comparative study recruited liver cirrhosis patients from the Gastroenterology clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, and matched them with healthy controls. Various tests, including serum albumin, bilirubin, creatinine, and psychometric HE tests, were conducted on the patients, while abdominal ultrasounds and vitamin D assessments were done for all participants. Child–Pugh and MELD scores were calculated for the cirrhosis patients. Covert HE was diagnosed if psychometric test completion time exceeded the mean plus 2 standard deviations of the controls, while overt HE was graded using the West Haven Criteria. A total of 212 subjects were recruited, including 106 liver cirrhosis patients and 106 controls. The median serum vitamin D level was 27.12 ng/ml in patients and 47.50 ng/ml in controls. Vitamin D levels negatively correlated with liver cirrhosis severity, as measured by the Child–Pugh (r = − 0.56, p < 0.001) and MELD sodium scores (r = − 0.39, p < 0.001). Serum vitamin D showed a strong negative correlation with overt HE grades (r = − 0.68, p < 0.001). No significant correlation was found between vitamin D levels and covert HE (NCTA, r = − 0.043, p = 0.762; NCTB, r = − 0.010, p = 0.943). Patients with overt HE had significantly lower vitamin D levels (median 15.00 ng/ml) than those without HE (median 34.00 ng/ml) or with covert HE (median 34.00 ng/ml), p < 0.001. No significant difference in vitamin D levels was observed between covert HE patients and those without HE (p = 1.00). Vitamin D deficiency is common in liver cirrhosis patients, correlates with disease severity, and is linked to hepatic encephalopathy. Screening for vitamin D insufficiency is recommended for all cirrhosis patients with hepatic encephalopathy.