Study of Serum Vitamin B12 and Vitamin D Levels in Patients of Cirrhosis

“Cirrhosis is defined as the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury, leading to portal hypertension and End Stage Liver Disease (ESLD) progressing to Cirrhosis and finally leading to decompensated liver disease.”

Cirrhosis is one of the leading causes of death in Asia as it ranks tenth most common cause of death in US, whereas worldwide, it is the 12th most common cause. Medical treatments that may slow down the progression of compensated cirrhosis to decompensated cirrhosis are under research phase. Liver Transplantation is however the only option in a selected subgroup of patients with ESLD and HCC.

Vitamin D is also known to have multiple extraskeletal functions. The liver is the main organ involved in the synthesis and metabolism of vitamin D after kidneys. 25-hydroxylation occurs inliver thereby converting it into active form. There are various experimental studies have demonstrated an increase in vitamin D deficiency prevalance and its insufficiency in patients with chronic liver disease and cirrhosis. It is often seen that sometimes even in the absence of cirrhosis, vitamin D deficiency may be detected in the majority of subjects. However those subjects who had cirrhosis, vitamin D deficiency(

There are various studies that state that vitamin D deficiency is related to the pathophysiology of cirrhosis.There are studies which have proven (to some extent) that levels of vitamin d are inversly correlated with liver dysfunction as evidenced by Child Pugh score and MELD score Also, vitamin D deficiency has been implicated for increase in the risk for overall mortality and infections in patients with cirrhosis. Recently, a study revealed an increase in MELD score seen in transplant cases to be associated with deficiency of Vitamin D.

The liver storage organ for fat soluble vitamins, vitamin B12 is one of them. Liver stores an estimated 1 mg of it. In Patients with chronic liver disease or cirrhosis serum vitamin B12 is often found to be elevated of serum vitamin B12 and However its normal values were also found in some patients, particularly in long-standing portal cirrhosis.

Some studies have indicated that elevated serum levels of vitamin B12 might be a sign of a serious and life-threatening disease. It has been observed that highly elevated vitamin B12 levels in patients with advanced stages of viral liver cirrhosis. There are only one report that demonstrated the association of vitamin B12 level with disease severity and mortality in hepatitis B virus infection with short term. No reports have evaluated the dynamics of vitamin B12 in chronic viral hepatitis. Accordingly, the present study aimed to evaluate the relationship of serum vitamin B12 between the disease severity and long term prognosis of liver disease in patients with cirrhosis.