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Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients.

Abstract

OBJECTIVES

Low levels of vitamin D are associated with a higher mortality in cirrhotic patients, but the role of this deficiency is still unknown. The purpose of this study was to assess the levels of vitamin D in cirrhotic patients with and without bacterial infection.

METHODS

25-hydroxy (25-OH) vitamin D was assessed by immunoassay in 88 patients hospitalized in our hepatology unit.

RESULTS

The causes of cirrhosis were mainly alcohol (70%), hepatitis C (10%), or both (9%). Infections (n=38) mainly included bacteriemia (21%), urinary tract infections (24%), and spontaneous bacterial peritonitis (29%). A severe deficiency in vitamin D (<10 ng/ml) was observed in 56.8% of patients. Infections were more frequent in patients with a severe deficiency compared with the others (54 vs. 29%, P=0.02). A severe deficiency in vitamin D was a predictive factor of infection (odds ratio=5.44 (1.35-21.97), P=0.017) independently of the Child-Pugh score (odds ratio=2.09 (1.47-2.97) P=0.00004) and the C-reactive protein level (odds ratio=1.03 (1.002-1.052), P=0.03) in a logistic regression also including the alanine amino transferase (not significant). By a Cox regression analysis, only the presence of an infection was significantly associated with mortality (relative risk=3.24 (1.20-8.76), P=0.02) in a model also associating the Child-Pugh score (not significant) and the presence of a severe deficiency in vitamin D (not significant).

CONCLUSIONS

Low levels of 25-OH vitamin D were independently associated with bacterial infections in cirrhotic patients. The impact of 25-OH vitamin D supplementation on the infection rate and death of cirrhotic patients should be assessed in randomized trials.

Authors+Show Affiliations

1] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France [2] Centre Hospitalier Universitaire of Nice, Digestive Center, Pôle Référence Hépatite C, Hôpital de l'Archet 2, Nice, France [3] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France.Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France.Centre Hospitalier Universitaire of Nice, Biological Center, Nice, France.1] Centre Hospitalier Universitaire of Nice, Digestive Center, Pôle Référence Hépatite C, Hôpital de l'Archet 2, Nice, France [2] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France [3] Institut National de la Santé et de la Recherche Médicale (INSERM), 576, Immunology Department, Archet 1 Hospital, Nice, France.Centre Hospitalier of Pau, Digestive Center, Pau, France.Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK.1] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France [2] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France.1] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France [2] Centre Hospitalier Universitaire of Nice, Digestive Center, Pôle Référence Hépatite C, Hôpital de l'Archet 2, Nice, France [3] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24871371

Citation

Anty, Rodolphe, et al. "Low Levels of 25-Hydroxy Vitamin D Are Independently Associated With the Risk of Bacterial Infection in Cirrhotic Patients." Clinical and Translational Gastroenterology, vol. 5, 2014, pp. e56.
Anty R, Tonohouan M, Ferrari-Panaia P, et al. Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients. Clin Transl Gastroenterol. 2014;5:e56.
Anty, R., Tonohouan, M., Ferrari-Panaia, P., Piche, T., Pariente, A., Anstee, Q. M., ... Tran, A. (2014). Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients. Clinical and Translational Gastroenterology, 5, pp. e56. doi:10.1038/ctg.2014.6.
Anty R, et al. Low Levels of 25-Hydroxy Vitamin D Are Independently Associated With the Risk of Bacterial Infection in Cirrhotic Patients. Clin Transl Gastroenterol. 2014 May 29;5:e56. PubMed PMID: 24871371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients. AU - Anty,Rodolphe, AU - Tonohouan,M, AU - Ferrari-Panaia,P, AU - Piche,T, AU - Pariente,A, AU - Anstee,Q M, AU - Gual,P, AU - Tran,A, Y1 - 2014/05/29/ PY - 2014/03/07/received PY - 2014/03/10/revised PY - 2014/04/10/accepted PY - 2014/5/30/entrez PY - 2014/5/30/pubmed PY - 2014/5/30/medline SP - e56 EP - e56 JF - Clinical and translational gastroenterology JO - Clin Transl Gastroenterol VL - 5 N2 - OBJECTIVES: Low levels of vitamin D are associated with a higher mortality in cirrhotic patients, but the role of this deficiency is still unknown. The purpose of this study was to assess the levels of vitamin D in cirrhotic patients with and without bacterial infection. METHODS: 25-hydroxy (25-OH) vitamin D was assessed by immunoassay in 88 patients hospitalized in our hepatology unit. RESULTS: The causes of cirrhosis were mainly alcohol (70%), hepatitis C (10%), or both (9%). Infections (n=38) mainly included bacteriemia (21%), urinary tract infections (24%), and spontaneous bacterial peritonitis (29%). A severe deficiency in vitamin D (<10 ng/ml) was observed in 56.8% of patients. Infections were more frequent in patients with a severe deficiency compared with the others (54 vs. 29%, P=0.02). A severe deficiency in vitamin D was a predictive factor of infection (odds ratio=5.44 (1.35-21.97), P=0.017) independently of the Child-Pugh score (odds ratio=2.09 (1.47-2.97) P=0.00004) and the C-reactive protein level (odds ratio=1.03 (1.002-1.052), P=0.03) in a logistic regression also including the alanine amino transferase (not significant). By a Cox regression analysis, only the presence of an infection was significantly associated with mortality (relative risk=3.24 (1.20-8.76), P=0.02) in a model also associating the Child-Pugh score (not significant) and the presence of a severe deficiency in vitamin D (not significant). CONCLUSIONS: Low levels of 25-OH vitamin D were independently associated with bacterial infections in cirrhotic patients. The impact of 25-OH vitamin D supplementation on the infection rate and death of cirrhotic patients should be assessed in randomized trials. SN - 2155-384X UR - https://www.unboundmedicine.com/medline/citation/24871371/Low_Levels_of_25_Hydroxy_Vitamin_D_are_Independently_Associated_with_the_Risk_of_Bacterial_Infection_in_Cirrhotic_Patients_ L2 - http://dx.doi.org/10.1038/ctg.2014.6 DB - PRIME DP - Unbound Medicine ER -