16. A study of correlation between disturbances in calcium-pth-vitamin D axis and clinical severity of non cholestatic chronic liver disease

Background and Aims: The role of disturbance in Calcium-PTH-Vitamin D axis has been debated in people with Chronic Liver Disease (CLD) as liver is a important organ involved in Vitamin D metabolism. We aim to determine the prevalence, extent and amount of disturbance in serum calcium, parathyroid hormone (PTH) and Vitamin D in CLD patients and their correlation with severity of CLD. Methods: It is a prospective, cross sectional observational study. 80 patients (55 males & 25 females; mean age 47.06 ± 12.53 years) data was collected with confirmed diagnosis of non-cholestatic CLD between Nov 2017 and April 2018 and were graded severity with Child-Turcotte-Pugh (CTP) and Model for End Stage Liver Disease (MELD) score. Serum concentrations of 25-hydroxyvitamin D{25 (OH)D}, PTH, PT/INR, calcium, phosphorus, LFT were done. Fibroscan was done in all patients. Results: Causes of cirrhosis was Alcohol (n = 30), Hepatitis B (n = 20), Hepatitis C (n = 4), NASH (n = 9), Autoimmune (n = 2), Wilson (n = 3), cirrhosis secondary to EHPVO (n = 6) and NCPF (n = 6). Total Patients with CTP A (n = 26), CTP B (n = 30), and CTP C (n = 24). Serum 25 (OH)D levels were inadequate in 78 out of 80 patients. Vitamin D deficiency (<20 ng/ml) was found in 60 patients and Vitamin D insufficiency (20–30 ng/ml) found in 18 patients. Only 2 patients had adequate serum Vitamin D levels (>30 ng/ml). Secondary hyperparathyroidism (serum PTH > 65 pg/ml) was seen in only in 5 patients. Patients with CTP score >9 had significantly lower serum 25 (OH)D compared to CTP score <7[10.33 ± 2.85 ng/ml vs. 19.02 ± 7.41 ng/ml; p < 0.001]. Significant correlation was found between high Fibroscan value (>27 kPa) and lower serum 25 (OH)D (<20 ng/ml) levels (p < 0.001). Serum Vitamin D deficiency was predictive of coagulopathy, hyperbilirubinimea, hypoalbunemia, high MELD score and high fibrosis. Conclusions: Lower Vitamin D levels are very common in chronic liver disease even in absence of cholestasis. Serum vitamin D levels showed significant correlation with severity of CLD. Management and Treatment protocol for patients of CLD should include assessment and replacement of vitamin D wherever necessary. The authors have none to declare.