Vitamin D Deficiency Linked to Worse Autoimmune Hepatitis Outcomes

Mariana Nunes Ferreira, MD

Credit: Mariana Nunes Ferreira on X

New research suggests patients with autoimmune hepatitis who are deficient in vitamin D may face worse outcomes, including hospitalizations, intensive care unit admissions, acute hepatic failure, liver transplantation, and mortality.¹

Findings from the retrospective cohort study were presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD) in San Diego, California, and highlight the importance of screening for vitamin D deficiency in this patient population.¹

A growing body of evidence connects vitamin D with hepatic disease, although the specific mechanisms of the relationship between vitamin D status and liver health are not well understood. Vitamin D deficiency has also been linked to the development of autoimmune diseases, posing important questions about its potential role and impact on outcomes in autoimmune hepatitis.^2,3

“Vitamin D deficiency is linked to worse outcomes in patients with chronic liver diseases. However, data in patients with autoimmune hepatitis remain limited,” Mariana Nunes Ferreira, MD, an internal medicine resident at Lincoln Medical Center, and colleagues wrote.¹

To assess the impact of vitamin D deficiency on outcomes in individuals with autoimmune hepatitis, investigators conducted a retrospective cohort study using the TriNetX research network. Patients with autoimmune hepatitis were matched using propensity score matching and stratified based on whether they had sufficient vitamin D levels, defined as 25-hydroxyvitamin ≥ 30 ng/mL; vitamin D insufficiency, defined as 25-hydroxyvitamin D 20-29.9 ng/mL; and vitamin D deficiency, defined as 25-hydroxyvitamin D < 20 ng/mL.¹

The primary outcome was all-cause mortality among adult patients with autoimmune hepatitis. Secondary outcomes included acute hepatic failure, liver transplantation, all-cause hospitalizations, all-cause critical care admissions, and trends in liver chemistries. Investigators adjusted these outcomes for demographics, clinical covariates, and social determinants of adverse health outcomes.¹

A total of 1186 patients with autoimmune hepatitis and vitamin D deficiency were identified and propensity matched with 1186 patients with normal vitamin D levels. Investigators noted patients with vitamin D deficiency had significantly increased odds for the following outcomes relative to those with normal vitamin D levels:

• All-cause mortality (adjusted odds ratio [aOR], 3.66; 95%CI, 2.51-5.33)
• All-cause hospitalizations (aOR, 2.62; 95% CI, 2.13-3.22)
• Critical care unit admissions (aOR, 2.56; 95% CI, 1.86-3.52)
• Hepatic failure (aOR, 2.72; 95% CI, 2.10-3.52)
• Liver transplant (aOR, 2.64; 95% CI, 1.27-5.49)

Additionally, investigators pointed out patients with vitamin D deficiency had significantly increased levels of AST at 3 months (P = .001), 6 months (P = .009), and 12 months of follow-up (P = .032), as well as ALT at 1 month (P = .042) and 3 months of follow-up (P = .041). TB (P <.001) and INR (P ≤.01, except at 3 months) were also greater in patients with vitamin D deficiency, whereas levels of albumin (P <.001) and platelets (P <.001) were lower.¹

Of note, investigators did not observe any overall significant differences in creatinine levels on further follow-up visits. When comparing patients with normal vitamin D levels to those with vitamin D insufficiency, they did not find any significant differences between the groups.¹

“Patients with autoimmune hepatitis may benefit from periodic screening for vitamin D deficiency, in accordance with AASLD guidelines, and treatment of individuals with concomitant vitamin D deficiency,” investigators concluded.¹ “Larger prospective cohort studies are warranted to validate these findings.”

References

1. ^{Nunes Ferreira M, Kilani Y, Alsakarneh S, et al. Autoimmune Hepatitis and Vitamin D Deficiency: A Nationwide Perspective. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}
2. ^{Keane JT, Elangovan H, Stokes RA, et al. Vitamin D and the Liver-Correlation or Cause? Nutrients. doi:10.3390/nu10040496.}
3. ^{Athanassiou L, Kostoglou-Athanassiou I, Koutsilieris M, et al. Vitamin D and Autoimmune Rheumatic Diseases. Biomolecules. doi:10.3390/biom13040709.}