title: Serum vitamin D level is associated with disease severity and response to ursodeoxycholic acid in primary biliary cirrhosis.
abstract: BACKGROUND
  Serum vitamin D levels are associated with bone complications in patients with primary biliary cirrhosis (PBC). Increasing evidence suggests a nonskeletal role of vitamin D in various autoimmune and liver diseases.
  
  
  OBJECTIVE
  To investigate the clinical relevance of vitamin D levels in PBC, especially their association with the therapeutic effects of ursodeoxycholic acid (UDCA).
  
  
  METHODS
  Consecutive PBC patients were retrospectively reviewed. 25-hydroxyvitamin D [25(OH)D] levels were determined in frozen serum samples collected before initiation of UDCA treatment. Response to UDCA was evaluated by Paris-I and Barcelona criteria. Logistic regressions were performed to identify the treatment response-associated parameters.
  
  
  RESULTS
  Among 98 patients, the mean serum 25(OH)D concentration was 17.9 ± 7.6 ng/mL. 25(OH)D levels decreased with increasing histological stage (P = 0.029) and were negatively correlated with bilirubin and alkaline phosphatase levels. After 1 year of UDCA therapy, 31 patients failed to achieve complete response according to Paris-I criteria. The baseline 25(OH)D level was significantly lower in nonresponders (14.8 ± 6.4 vs. 19.3 ± 7.6 ng/mL, P = 0.005). Vitamin D deficiency at baseline was associated with an increased risk of incomplete response independent of advanced stages (OR = 3.93, 95% CI = 1.02-15.19, P = 0.047). Similar results were obtained when biochemical response was evaluated by Barcelona criteria. Furthermore, 25(OH)D levels were lower in patients who subsequently suffered death or liver transplantation (12.1 ± 4.6 vs. 18.4 ± 7.6 ng/mL, P = 0.023).
  
  
  CONCLUSIONS
  25(OH)D level is associated with biochemical and histological features in PBC. Pre-treatment vitamin D status is independently related to subsequent response to UDCA. Our results suggest that vitamin D status may have important clinical significance in PBC.
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: G-Y
authors.initials: GY
authors.lastname: Guo
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: Y-Q
authors.initials: YQ
authors.lastname: Shi
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: X
authors.initials: X
authors.lastname: Ren
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: Z-Y
authors.initials: ZY
authors.lastname: Han
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: C-C
authors.initials: CC
authors.lastname: Guo
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: L-N
authors.initials: LN
authors.lastname: Cui
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: J-B
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: N
authors.initials: N
authors.lastname: Wang
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Han
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: X-M
authors.initials: XM
authors.lastname: Zhou
authors.affiliation: Division of Hepatology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.|State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
authors.forename: D-M
authors.initials: DM
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications
chemical_list: D002756:Cholagogues and Choleretics; D014807:Vitamin D; D014580:Ursodeoxycholic Acid; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase