A Silent Marker in Cirrhosis: The Toll of Vitamin D Deficiency on Age, Gender, and Quality of Life

Background: Beyond the classic markers of liver failure, vitamin D deficiency has emerged as a silent driver of adverse outcomes in cirrhosis.By worsening survival prospects and daily functioning, it places an additional burden on patients.However, its prevalence, gender distribution, and impact on health-related quality of life (HRQoL) remain underexplored in South Asian populations.Materials and methods: We performed a cross-sectional analysis of 270 individuals with cirrhosis, confirmed by clinical and radiologic criteria, at a tertiary hospital in Faisalabad, Pakistan.Serum 25-hydroxyvitamin D [25(OH)D] concentrations were determined, with deficiency defined as < 20 ng/mL.Disease stage was classified by the Child-Pugh score, and HRQoL was measured using the SF-8 survey.Statistical evaluation included Chi-square, ANOVA, and multivariable linear regression.Results: Overall, 57.8% of participants were vitamin D deficient.The frequency rose with advancing cirrhosis (16.7% in class A, 51.9% in class B, 86.8% in class C; p < 0.001).Women were affected more often than men (69.5 vs 48.7%; p = 0.001).Deficient patients had markedly lower HRQoL scores (mean SF-8: 29.1 ± 6.8) compared with those with sufficient levels (17.2 ± 4.5; p < 0.001).The poorest outcomes were seen in vitamin D-deficient females with class C disease.In regression analysis, vitamin D deficiency (β = 0.430, p < 0.001), advanced Child-Pugh stage (β = 0.455, p < 0.001), and older age (β = 0.132, p = 0.001) were independent predictors of impaired HRQoL, whereas gender lost significance after adjustment.Conclusion: Vitamin D deficiency is widespread among cirrhotic patients, with a higher burden in women and in advanced disease.Both deficiency and disease severity independently contribute to reduced quality of life.Incorporating vitamin D screening and supplementation into cirrhosis care may be beneficial, and randomized trials are warranted to assess clinical impact.Clinical significance: Vitamin D deficiency is common in cirrhosis and contributes independently to worsening quality of life, particularly in women, older patients, and those with advanced disease.Incorporating vitamin D testing into routine management may provide an inexpensive, practical opportunity to improve patient outcomes, while further trials should clarify the therapeutic benefit of supplementation.