A Silent Marker in Cirrhosis: The Toll of Vitamin D Deficiency on Age, Gender, and Quality of Life.

Background: Beyond the classic markers of liver failure, vitamin D deficiency has emerged as a silent driver of adverse outcomes in cirrhosis. By worsening survival prospects and daily functioning, it places an additional burden on patients. However, its prevalence, gender distribution, and impact on health-related quality of life (HRQoL) remain underexplored in South Asian populations. Materials and methods: We performed a cross-sectional analysis of 270 individuals with cirrhosis, confirmed by clinical and radiologic criteria, at a tertiary hospital in Faisalabad, Pakistan. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were determined, with deficiency defined as < 20 ng/mL. Disease stage was classified by the Child-Pugh score, and HRQoL was measured using the SF-8 survey. Statistical evaluation included Chi-square, ANOVA, and multivariable linear regression. Results: Overall, 57.8% of participants were vitamin D deficient. The frequency rose with advancing cirrhosis (16.7% in class A, 51.9% in class B, 86.8% in class C; Conclusion: Vitamin D deficiency is widespread among cirrhotic patients, with a higher burden in women and in advanced disease. Both deficiency and disease severity independently contribute to reduced quality of life. Incorporating vitamin D screening and supplementation into cirrhosis care may be beneficial, and randomized trials are warranted to assess clinical impact. Clinical significance: Vitamin D deficiency is common in cirrhosis and contributes independently to worsening quality of life, particularly in women, older patients, and those with advanced disease. Incorporating vitamin D testing into routine management may provide an inexpensive, practical opportunity to improve patient outcomes, while further trials should clarify the therapeutic benefit of supplementation. How to cite this article: Shafqat U, Rasool S, Azhar S,