Low Serum Vitamin D During Remission Increases Risk of Clinical Relapse in Patients With Ulcerative Colitis

Abstract

Background & aims: Vitamin D levels have been associated with disease activity in patients with ulcerative colitis (UC), but it is unclear whether they affect the risk of disease relapse. We sought to determine the association between baseline vitamin D levels during a period of clinical remission and risk of subsequent UC relapse.

Methods: We performed a physician-blinded prospective study of 70 patients with UC in clinical remission followed up after a surveillance colonoscopy at a tertiary academic medical center. Serum samples were collected at the time of colonoscopy and baseline endoscopic and histologic activity were determined. Levels of 25-hydroxy-vitamin D were measured using an enzyme-linked immunosorbent assay. The primary outcome was rate of clinical relapse, determined over 12 months.

Results: The mean baseline vitamin D level was lower among patients with relapse (29.5 ng/mL) than without (50.3 ng/mL) (P = .001). Remission vitamin D level (≤35 ng/mL) was associated with a risk of clinical relapse (odds ratio, 1.25; 95% confidence interval [CI], 1.01-1.56; P = .044) over 12 months, independent of endoscopic or histologic grade at enrollment. A receiver operating characteristic curve of vitamin D levels for the outcome of relapse had an area under the curve of 0.72; and a serum level of 35 ng/mL or less had a sensitivity of 70% (95% CI, 46%-88%) and a specificity of 74% (95% CI 57%-83%) for predicting risk of clinical relapse.

Conclusions: Serum levels of vitamin D of 35 ng/mL or less during periods of clinical remission increase the risk of UC relapse. Clinical trials to obtain vitamin D levels higher than this threshold should be considered.

Keywords: Biomarker; IBD; Relapse Prevention.

Figure 1

Mean baseline Vitamin D level was lower among subsequent relapsers vs non-relapsers: 29.5 ng/mL vs 50.3 ng/mL (*p =0.001)

Figure 2

A Receiver Operating Characteristic (ROC) curve of vitamin D levels for the outcome of relapse had an area under the curve (AUC) of 0.72 (p<0.01). Sensitivity 70.0% (95% CI 45.7%-88.1%), Specificity 73.5% (95% CI 56.7%-83.4), Likelihood Ratio 2.64.

Figure 3

Time to Event Analysis of Effect of Vitamin D Levels on Risk of Clinical Relapse in Patients with Ulcerative Colitis in Remission. Patients with vitamin D ≤ 35 ng/mL had a shorter time to clinical relapse (p< 0.001, by Log Rank Mantel Cox) compared to UC patients with Vitamin D > 35 ng/mL.