Falsely Elevated Serum Vitamin B12Levels Were Associated with the Severity and Prognosis of Chronic Viral Liver Disease.
Vitamin B12is stored primarily in the liver, and highly elevated serum vitamin B12levels occur in acute hepatitis and severe alcoholic liver disease. We evaluated the relationship between vitamin B12levels and liver disease severity and long term prognosis in patients with chronic viral hepatitis and cirrhosis.



We enrolled 90 patients (57 men, 33 women) with chronic viral hepatitis and cirrhosis who admitted to our hospital as a prospective cohort study. Overall, 37 patients had chronic hepatitis and 53 had cirrhosis (Child-Pugh A 33, B 13, and C 7); 57 patients had primary liver cancer. Serum vitamin B12concentration and holotranscobalamin (holoTC) II (active form of vitamin B12) were determined and followed prospectively for at least 5 years.



Mean total serum vitamin B12concentration was significantly higher in Child-Pugh C (1308 ± 599 pg/mL) compared to those with chronic hepatitis (655 ± 551 pg/mL), Child-Pugh A (784 ± 559 pg/mL), and Child-Pugh B (660 ± 464 pg/mL) (P= 0.036) Presence of primary liver cancer also influenced serum vitamin B12levels [657 (167-2956) vs. 432 (189-2956);P= 0.015]. Patients were divided into quartiles by vitamin B12level. Patients without primary liver cancer in quartile 4 (≥ 880 pg/mL) demonstrated significantly poorer prognosis than those in quartiles 1-3 (< 880 pg/mL) (P= 0.023). The percentage of holohaptocorrin (holoHC) [(total vitamin B12- holoTC II) × 100] was significantly higher in Child-Pugh B and C 86 (80-87)% than chronic hepatitis and Child-Pugh A 77 (31-89)% (P= 0.006) Multivariate analysis indicated serum vitamin B12levels (HR = 1.001,P= 0.029) as a prognostic factor.



Falsely elevated serum vitamin B12levels mainly composed of increased holoHC were associated with severity (Child-Pugh C and primary liver cancer) and prognosis in chronic viral liver disease.
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Takaaki
T
Sugihara
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Masahiko
M
Koda
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Toshiaki
T
Okamoto
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Kenichi
K
Miyoshi
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Tomomitsu
T
Matono
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Kenji
K
Oyama
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Keiko
K
Hosho
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Jun-Ichi
JI
Okano
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Hajime
H
Isomoto
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Yoshikazu
Y
Murawaki
holotranscobalamin; liver cirrhosis; prognosis; viral hepatitis; vitamin B12