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

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.