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Use of Serum Vitamin B12 Level as a Marker to Differentiate Idiopathic Noncirrhotic Intrahepatic Portal Hypertension from Cryptogenic Cirrhosis

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Abstract

Background and Aims

Idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH) is often mis-diagnosed as cryptogenic cirrhosis. Serum vitamin B12 levels can be raised in cirrhosis, probably because of excess release or reduced clearance. Because NCIPH is characterised by long periods of preserved liver function, we examined whether serum B12 level could be used as a marker to differentiate NCIPH from cryptogenic cirrhosis.

Methods

We analysed serum B12 levels in 45 NCIPH and 43 cryptogenic cirrhosis patients from January 2009 to September 2011.

Results

Serum B12 levels were significantly lower in NCIPH patients than in cryptogenic cirrhosis patients (p < 0.001) and were useful in differentiating the two disorders (area under ROC: 0.84; 95 % C.I: 0.76–0.93). Low serum B12 level (≤250 pg/ml) was noted in 25/72 (35 %) healthy controls, 14/42 (33 %) NCIPH patients, and 1/38 (3 %) cryptogenic cirrhosis patients. In patients with intrahepatic portal hypertension of unknown cause, serum B12 level ≤ 250 pg/ml was useful for diagnosing NCIPH (positive predictive value: 93 %, positive likelihood ratio 12.7), and serum B12 level >1,000 pg/ml was useful in ruling out NCIPH (negative predictive value: 86 %, negative likelihood ratio: 6.67). Low serum B12 levels (≤250 pg/ml) correlated with diagnosis of NCIPH after adjusting for possible confounders (O.R: 13.6; 95 % C.I:1.5–126.2). Among patients in Child’s class A, serum B12 level was ≤250 pg/ml in 14/35 NCIPH patients compared with 1/21 cryptogenic cirrhosis patients (O.R: 13.3; 95 % C.I: 1.6–111).

Conclusion

Serum vitamin B12 level seems to be a useful non-invasive marker for differentiation of NCIPH from cryptogenic cirrhosis.

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Abbreviations

NCIPH:

Idiopathic non-cirrhotic intrahepatic portal hypertension

ROC:

Receiver operating characteristics

O.R.:

Odds ratio

C.I.:

Confidence interval

HVPG:

Hepatic venous pressure gradient

HBsAg:

Hepatitis B surface antigen

HCV:

Hepatitis C virus

MELD:

Model for endstage liver disease

ALT:

Alanine aminotransferase

ADAMTS13:

A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13

HBV:

Hepatitis B virus

DNA:

Deoxyribonucleic acid

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Authors and Affiliations

  1. Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Ashish Goel, Kadiyala Madhu, K. G. Sajith, Uday Zachariah, Jeyamani Ramachandran, George M. Chandy, Elwyn Elias & C. E. Eapen

  2. Pathology Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Banumathi Ramakrishna

  3. Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Jayaprakash Muliyil

  4. Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Shyamkumar N. Keshava

  5. Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    R. Selvakumar

  6. Emeritus Professor, Liver Unit, University Hospital Birmingham, Birmingham, UK

    Elwyn Elias

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  1. Ashish Goel
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  2. Banumathi Ramakrishna
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  12. C. E. Eapen
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Correspondence to C. E. Eapen.

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Goel, A., Ramakrishna, B., Muliyil, J. et al. Use of Serum Vitamin B12 Level as a Marker to Differentiate Idiopathic Noncirrhotic Intrahepatic Portal Hypertension from Cryptogenic Cirrhosis. Dig Dis Sci 58, 179–187 (2013). https://doi.org/10.1007/s10620-012-2361-7

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  • DOI: https://doi.org/10.1007/s10620-012-2361-7

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