SERUM-LIPID AND FAT-SOLUBLE VITAMIN LEVELS IN PRIMARY SCLEROSING CHOLANGITIS

We reviewed the initial lipid and fat-soluble vitamin levels in 56 pat ients with primary sclerosing cholangitis (PSC) enrolled in a randomiz ed, placebo-controlled trial evaluating ursodeoxycholic acid. We also evaluated lipid and vitamin levels in a group of 87 patients with adva nced PSC being evaluated for liver transplantation. Of the patients en tering the therapeutic trial, 41% had total serum cholesterol levels g reater than the 95th percentile, whereas only 20% had high-density lip oprotein cholesterol levels above normal and only one (2%) had an elev ated triglyceride level. Total cholesterol levels were correlated with serum bilirubin levels and were lower in early versus later histologi c stages (206 +/- 61 vs. 248 +/- 79, p = 0.04). Of the 87 pretransplan t patients, 29% had elevated serum cholesterol levels and 17% had elev ated serum triglyceride levels. Total serum cholesterol levels correla ted inversely with total serum bilirubin levels in this group. In pati ents in the therapeutic trial, vitamin A deficiency was seen in 40%, v itamin D deficiency in 14%, and vitamin E deficiency in 2% of those te sted. More prominent deficiencies of fat-soluble vitamins occurred in the pretransplant group of patients, with 82% deficient in vitamin A, 57% deficient in vitamin D, and 43% deficient in vitamin E. We conclud e that hypercholesterolemia and fat-soluble vitamin deficiencies are f requent in patients with PSC and are more common with more severe dise ase. Patients with PSC, especially with advanced liver disease, should be screened for fat-soluble vitamin deficiencies and supplemented acc ordingly.