Prognostic associations of vitamin D deficiency with disease severity, survival, and complications in alcohol-related liver disease

Background Vitamin D deficiency has been associated with adverse outcomes in various chronic diseases, and its relevance in alcohol-related liver disease (ALD) has attracted increasing attention. This study aimed to evaluate the prognostic significance of vitamin D status in hospitalized patients with ALD. Methods We retrospectively analyzed 115 hospitalized patients with ALD between 2021 and 2024. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL. Statistical analyses were performed using Spearman’s correlation, logistic regression, Kaplan–Meier survival analysis, multivariable Cox proportional hazards models, and receiver operating characteristic (ROC) curve analysis. Results Vitamin D deficiency was present in 35.7% of patients. After adjustment for season, vitamin D deficiency was associated with alcoholic hepatitis, cirrhosis, ascites, sarcopenia, total bilirubin, Model for End-Stage Liver Disease score, and Maddrey discriminant function ≥ 32 (all p < 0.05). In multivariable logistic regression, vitamin D deficiency independently predicted greater disease severity (OR 3.087, 95% CI 1.034–9.215; p = 0.043). Kaplan–Meier analysis showed reduced survival among patients with vitamin D deficiency (log-rank p = 0.025), and multivariable Cox regression confirmed vitamin D deficiency as an independent predictor of mortality (HR 3.179, 95% CI 1.064–9.500; p = 0.038). ROC analyses indicated modest discrimination of serum 25(OH)D for sarcopenia and spontaneous bacterial peritonitis (SBP), with optimal cut-offs of 22.74 and 14.2 ng/mL, respectively. Conclusion In this cohort of hospitalized ALD patients, vitamin D deficiency was associated with greater disease severity, reduced survival, and increased risk of sarcopenia and SBP. Serum 25(OH)D may serve as a prognostic marker of overall disease burden. Given the retrospective design, limited event numbers, and short follow-up, these findings should be considered exploratory and require confirmation in prospective studies.