Abstract | UNLABELLED:
von Willebrand factor antigen (vWF-Ag) is elevated in patients with liver cirrhosis, but the clinical significance is unclear. We hypothesized that vWF-Ag levels may correlate with portal pressure, measured by hepatic venous pressure gradient (HVPG), and predict clinically significant portal hypertension ( CSPH; HVPG ≥ 10 mmHg), decompensation and mortality. Portal hemodynamics were assessed by HVPG measurement, whereas vWF-Ag levels were measured by enzyme-linked immunosorbent assay. During follow-up, complications of liver cirrhosis, death or transplantation were recorded. Two hundred and eighty-six patients (205 male and 81 female; mean age, 56 years) with liver cirrhosis were included. vWF-Ag correlated with HVPG (r = 0.69; P < 0.0001) and predicted CSPH independently of Child Pugh score. Higher vWF-Ag levels were associated with varices (odds ratio [OR] = 3.27; P < 0.001), ascites (OR = 3.93; P < 0.001) and mortality (hazard ratio: 4.41; P < 0.001). Using a vWF-Ag cut-off value of ≥ 241%, the AUC for detection of CSPH in compensated patients was 0.85, with a positive predictive value and negative predictive value of 87% and 80%, respectively. Compensated patients had 25% mortality after 53 months if the vWF-Ag was <315% compared to 15 months in patients with vWF-Ag >315% (P < 0.001). Decompensated patients had a mortality of 25% after 37 and 7 months if their vWF-Ag was <315% and >315%, respectively (P = 0.002). In compensated patients with a vWF-Ag >315% median time to decompensation or death was 32 months compared with 59 months in patients with vWF-Ag <315%. vWF-Ag equals Model for End-Stage Liver Disease (MELD) in mortality prediction (area under the curve [AUC] = 0.71 for vWF-Ag versus AUC = 0.65 for MELD; P = 0.2). CONCLUSION: vWF-Ag is a new, simple and noninvasive predictor of CSPH. A vWF-Ag cut-off value at 315% can clearly stratify patients with compensated and decompensated liver cirrhosis in two groups with completely different survival. vWF-Ag may become a valuable marker for the prediction of mortality in patients with liver cirrhosis in clinical practice.
|
Authors | Monika Ferlitsch, Thomas Reiberger, Matthias Hoke, Petra Salzl, Bernadette Schwengerer, Gregor Ulbrich, Berit Anna Payer, Michael Trauner, Markus Peck-Radosavljevic, Arnulf Ferlitsch |
Journal | Hepatology (Baltimore, Md.)
(Hepatology)
Vol. 56
Issue 4
Pg. 1439-47
(Oct 2012)
ISSN: 1527-3350 [Electronic] United States |
PMID | 22532296
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright © 2012 American Association for the Study of Liver Diseases. |
Chemical References |
- Biomarkers
- von Willebrand Factor
|
Topics |
- Adult
- Biomarkers
(blood)
- Cohort Studies
- Confidence Intervals
- Disease Progression
- Enzyme-Linked Immunosorbent Assay
- Female
- Follow-Up Studies
- Humans
- Hypertension, Portal
(blood, mortality, physiopathology)
- Liver Cirrhosis
(blood, mortality, pathology, physiopathology)
- Liver Failure
(blood, mortality, pathology, physiopathology)
- Male
- Middle Aged
- Multivariate Analysis
- Odds Ratio
- Predictive Value of Tests
- Proportional Hazards Models
- ROC Curve
- Retrospective Studies
- Risk Assessment
- Severity of Illness Index
- Survival Analysis
- Time Factors
- von Willebrand Factor
(metabolism)
|