Vitamin E status in patients with liver cirrhosis: Normal or deficient?

The study aim was to compare the ratio of vitamin E to serum cholesterol wi th the serum vitamin E level alone as a measure of vitamin E status in pati ents with different degrees of liver dysfunction. Assessment of serum vitam in E and total serum cholesterol was performed in 85 patients with liver ci rrhosis at Child's stage A (n = 26), B (n = 26), and C (n = 33) and 50 pati ents with noncirrhotic liver disease. As surrogate markers of liver functio n, 7 alpha-hydroxycholesterol and prealbumin concentrations and the plasma prothrombin time were determined. Mean serum vitamin E concentrations in Ch ild A, B, and C patients were 27.4%, 36.9%, and 37.3% lower, respectively, than in healthy controls (P <.01). Twelve of 26 Child A, 14 of 26 Child B, and 14 of 33 Child C patients had vitamin E deficiency with respect to the absolute values, ie, serum levels less than 13.76 mu mol/L (5% percentile o f healthy controls). In contrast, only two of 26 Child A, five of 26 Child B, and five of 33 Child C patients (P <.01 for Child A/B and P <.05 for Chi ld C) were vitamin E-deficient according to the serum vitamin E to choleste rol ratio, ie, less than 2.86 mu mol/mmol. Serum vitamin E was correlated s ignificantly with prealbumin, 7 alpha-hydroxycholesterol, and the plasma pr othrombin time, but the vitamin E to cholesterol ratio was not. Correcting serum vitamin E for total serum cholesterol in patients with liver cirrhosi s leads to the phenomenon of reduced serum vitamin E levels inadvertently s hifted toward normal values. In patients with liver cirrhosis, the absolute vitamin E concentration correlates better with the typical clinical and bi ochemical findings of the disease than the vitamin E to cholesterol ratio. Therefore, a considerable number of patients with advanced liver cirrhosis might actually be vitamin E-deficient. Copyright (C) 1999 by W.B. Saunders Company.