Serum vitamin B12 levels as indicators of disease severity and mortality of patients with acute-on-chronic liver failure.

The study was designed to investigate the association between vitamin B12 levels and patients with acute-on-chronic liver failure (AoCLF). In addition, we analyzed whether B12 is associated with mortality in the AoCLF patients.One hundred five patients with AoCLF and 44 healthy controls (HCs) were prospectively studied. In all subjects, a blood sample was collected at admission to examine liver function, renal function, international normalized ratio and B12 levels. A total of 9 clinical chemistry and biochemical variables were analyzed for possible association with outcomes by using Cox proportional hazards and multiple regression models.AoCLF patients had significantly higher B12 levels at admission compared with HCs (AoCLF patients vs HCs, median 1218 pg/ml, mean 1736.2 pg/ml, SD, 1294.6 vs 504 pg/ml, 529.8 ± 149.8 pg/ml, P<0.001). Elevated B12 levels were associated with increased severity of liver disease and 3-month mortality rate. Multivariate analysis demonstrated that B12 levels and the model for end-stage liver disease score were independent predictors for mortality (both P<0.001).B12 levels were significantly higher in AoCLF patients than in HCs and elevated B12 were associated with increased severity of disease. Moreover, B12 levels are an independent predicting factor for the 3-month mortality rate in AoCLF patients.