Improvement in fatigue status in patients with liver cirrhosis due to chronic viral hepatitis C after Vitamin D supplementation

Introduction: Liver cirrhosis affects vitamin D metabolism, the deficiency of which was shown to cause non-specific musculoskeletal pain and fatigue. The aim is to investigate the effect of vitamin D supplementation on fatigue in patients with liver cirrhosis due to chronic hepatitis C. Materials and methods: Fifty Egyptian patients with liver cirrhosis due to chronic hepatitis C were included. Liver function tests, serum calcium 25-hydroxycholecalciferol were measured. The fatigue severity scale (FSS) and fatigue impact scale (FIS) were done at the baseline and one month after vitamin D3 administration (200,000 IU IM single dose). Results: 37 patients were Child B, 13 Child C. Mean±SE of serum 25(OH)cholecalciferol was 4.23±0.60 ng/ml. Fatigue values were significantly higher in Child C than Child B patients, 56.69±0.74 vs. 47.81±1.03 respectively for FSS (p=0.000041) and 121.3±1.49 vs. 108.4±1.8 respectively for FIS (p=0.000599). The improvement in FSS was 31.8%±11.2, with 95% CI 35.0 to 28.6. The improvement in FIS was 39.3%±14.3, with 95% CI 43.4 to 35.2. The percentage decrement in fatigue scores was significantly lower in Child C patients as compared to Child B patients; 18.8%±3.4 vs. 36.4%±9.1 respectively for FSS (p<0.0001) and 23%±6 vs. 44.9%±11.9 respectively for FIS (p<0.0001). Conclusion: Patients with liver cirrhosis due to chronic HCV hepatitis had severe fatigue which improved significantly after administration of vitamin D3. Routine screening and replacement of vitamin D3 are thus recommended in such patients to improve their quality of life.