title: Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients.
abstract: OBJECTIVE
  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.affiliation: 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.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Anty
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France.
authors.forename: M
authors.initials: M
authors.lastname: Tonohouan
authors.affiliation: Centre Hospitalier Universitaire of Nice, Biological Center, Nice, France.
authors.forename: P
authors.initials: P
authors.lastname: Ferrari-Panaia
authors.affiliation: 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.
authors.forename: T
authors.initials: T
authors.lastname: Piche
authors.affiliation: Centre Hospitalier of Pau, Digestive Center, Pau, France.
authors.forename: A
authors.initials: A
authors.lastname: Pariente
authors.affiliation: Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Q M
authors.initials: QM
authors.lastname: Anstee
authors.affiliation: 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.
authors.forename: P
authors.initials: P
authors.lastname: Gual
authors.affiliation: 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.
authors.forename: A
authors.initials: A
authors.lastname: Tran