Is Vitamin D Deficiency a Risk Factor for Spontaneous Bacterial Peritonitis?

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a severe worldwide liver condition. Objective: The aim of this study was investigating the association between serum 25(OH)D deficiency and the complications of hepatitis c virus (HCV) related cirrhosis, notably, SBP. Patients and Methods: This prospective case control study was carried out on 100 patients, with cirrhosis and ascites. The patients were divided into two groups: Group I cirrhotic patients with ascites and SBP, which were divided into two equal subgroups according to addition of 25(OH)D to treatment of SBP: group Ia did not receive vitamin D and group Ib received vitamin D. Group II: cirrhotic patients with simple ascites and without SBP. Group Ib of patients were receiving a dose of 2.000 I. U of 25 hydroxycholecalciferol per day for at least 1 week. Results: There was a significant correlation between serum vitamin D and end-stage liver disease (MELD) score (r = -0.51, P= 0.012; r = -0.37, P= 0.016, respectively) in subgroup (GI a) not receiving vitamin D and control group. Serum level of vitamin D was also significantly correlated with ascitic polymorphonuclear neutrophils (PMN) count (cell/µL) in both SBP subgroups (GI a and b) (r = -0.61, P= 0.002; r = -0.61, P= 0.002, respectively). The receiver operating characteristic (ROC) curve analysis estimated a sensitivity of 78.3%, a specificity of 69.0%, a positive predictive value (PPV) of 58%, a negative predictive value (NPV) of 85.3% and an accuracy of 73.7% at the best cutoff value of ≤13.96 (ng/mL). The AUC was 0.76 with a highly significant P-value < 0.001. A positive highly significant correlation between serum vitamin D and serum albumin was observed in both subgroups and control (r = 0.67, P = 0.001 and r =0.50, P=0.014, r = 0.44, P=0.004, respectively). Conclusions: MELD scores >15 were related with an increased risk of SBP. It was also shown that Escherichia coli and Staph aureus were the most frequent bacteria among SBP patients.