P62 Association between vitamin D deficiency and spontaneous bacterial peritonitis among sudanese patients with liver cirrhosis

Introduction

liver cirrhosis is a common consequence of chronic liver disease. Portal hypertension, ascites, hepatic encephalopathy, and spontaneous bacterial peritonitis (SBP) are the most common and serious complications of liver cirrhosis. There are multiple risk factors to develop SBP such as low ascitic fluid protein, low serum albumin, high serum bilirubin and advance liver cirrhosis. Vitamin D has an important role in immunity, and vitamin D deficiency had been observed in patient with severe liver cirrhosis complicated with SBP.

Objective

To study the association between vitamin D deficiency and spontaneous bacterial peritonitis among Sudanese patients with liver cirrhosis

Methods

This is a case control study . 99 patients were enrolled , they were divided into three groups .patients diagnosed with liver cirrhosis (LC) without having (SBP) 33patients, while Liver cirrhosis(LC) group with SBP 33 patients and control group 33) patients .Data regarding; demographics, diagnosis , assessment of liver severity and ,measurement of vitamin D level were collected Data collected, prepared, entered and analyzed by using (SPSS V. 21.0). The analysed data presented in tables and figures designed by Microsoft Excel 2010. ANOVA was used as significance test for continuous variables and Chi-Square for categorical variables. The P. value was considered as significant at level 0.05

Results

The majority of patients in LC with SBP group had deficient vitamin D level (<20 ng/ml) and suboptimal vitamin-D levels (20-30 ng/ml), where as those in LC without SBP and control groups had optimal vitamin-D levels (31-50 ng/ml).as shown in the following figure 1. The levels of vitamin-D were more deficient in patients with Child score -C (17.3±5.4 ng/ml) followed by Child score -B (20.7±5.8 ng/ml) and those with Child score -A (36.6±11.5 ng/ml). The difference was statistically significant (P= 0.000)Patients in LC with SBP group were more tended to be underweight (BMI mean= 18.4±2.5) in comparison to LC without SBP (BMI mean= 22.2±.6) and control groups (BMI mean= 26.1±3.8) with statistical significant difference (P= 0.000).Patients in LC with SBP were found to have severe liver disease as evidence by Child score -C unlike those without SBP those more tended to be Child score -A (P= 0.000).The levels of vitamin-D were more diminished in LC with SBP patients (21.5±8.5 ng/m) followed by LC without SBP (30.6±13 ng/ml) and control groups (37.4±12.3 ng/ml) with statistical significant difference (P< 0.005).

Conclusions

This Study concluded that ,majority of patients in liver cirrhosis with SBP have vitamin D deficiency or suboptimal levels. Also they have low BMI . Patients with severe liver cirrhosis ( child Pugh score class C ) have more deficient level of vitamin D .and are more tended to develop SBP