Mo2081 Von Willebrand Factor as a New Noninvasive Predictor of Clinically Significant Portal Hypertension and Mortality in Liver Cirrhosis

Background & AimsVon Willebrand factor antigen (vWF-Ag) is elevated in patients with liver cirrhosis, but the clinical significance is unclear. No noninvasive parameters are established to estimate portal hypertension. 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; defined as an HVPG ≥ 10 mmHg), its complications and mortality.MethodsPortal hemodynamics were assessed by HVPG measurement. vWF-Ag levels were measured by enzyme-linked immunosorbent assay. Study period was conducted from September 2006 to December 2011.ResultsWe included 286 patients (mean age, 56 years; 205 male and 81 female) with alcoholic, viral, and cryptogenic liver cirrhosis. vWF-Ag was significantly increased in patients with CSPH compared with patients without CSPH (P < .0001). HVPG correlated significantly with vWF-Ag (r = 0.64; P < .0001) and was able to predict CSPH independently of Child Pugh score. Using a vWF-Ag cutoff value of ≥241% the area under the curve (AUC) for detection of CSPH was 0.88 with a positive predictive value of 93% and a negative predictive value of 54%. Higher vWF-Ag levels were significantly associated with varices (odds ratio [OR], 3.27; P < .001), ascites (OR, 3.93; P < .001), and mortality (OR, 2.61; P < .0001). vWF-Ag equals the Model for End-Stage Liver Disease (MELD) score in mortality prediction (area under the receiver operating characteristic curve = 0.71 for vWF-Ag vs 0.65 for MELD; P = .2). Kaplan–Meier analysis shows the survival benefit for patients with vWF-Ag to be <324%.ConclusionAmong patients with liver cirrhosis, vWF-Ag is elevated and can discriminate between patients with CSPH and those without with a cutoff vWF-Ag of ≥241%. Further, vWF-Ag is a simple new marker for mortality prediction in patients with liver cirrhosis. Background & AimsVon Willebrand factor antigen (vWF-Ag) is elevated in patients with liver cirrhosis, but the clinical significance is unclear. No noninvasive parameters are established to estimate portal hypertension. 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; defined as an HVPG ≥ 10 mmHg), its complications and mortality. Von Willebrand factor antigen (vWF-Ag) is elevated in patients with liver cirrhosis, but the clinical significance is unclear. No noninvasive parameters are established to estimate portal hypertension. 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; defined as an HVPG ≥ 10 mmHg), its complications and mortality. MethodsPortal hemodynamics were assessed by HVPG measurement. vWF-Ag levels were measured by enzyme-linked immunosorbent assay. Study period was conducted from September 2006 to December 2011. Portal hemodynamics were assessed by HVPG measurement. vWF-Ag levels were measured by enzyme-linked immunosorbent assay. Study period was conducted from September 2006 to December 2011. ResultsWe included 286 patients (mean age, 56 years; 205 male and 81 female) with alcoholic, viral, and cryptogenic liver cirrhosis. vWF-Ag was significantly increased in patients with CSPH compared with patients without CSPH (P < .0001). HVPG correlated significantly with vWF-Ag (r = 0.64; P < .0001) and was able to predict CSPH independently of Child Pugh score. Using a vWF-Ag cutoff value of ≥241% the area under the curve (AUC) for detection of CSPH was 0.88 with a positive predictive value of 93% and a negative predictive value of 54%. Higher vWF-Ag levels were significantly associated with varices (odds ratio [OR], 3.27; P < .001), ascites (OR, 3.93; P < .001), and mortality (OR, 2.61; P < .0001). vWF-Ag equals the Model for End-Stage Liver Disease (MELD) score in mortality prediction (area under the receiver operating characteristic curve = 0.71 for vWF-Ag vs 0.65 for MELD; P = .2). Kaplan–Meier analysis shows the survival benefit for patients with vWF-Ag to be <324%. We included 286 patients (mean age, 56 years; 205 male and 81 female) with alcoholic, viral, and cryptogenic liver cirrhosis. vWF-Ag was significantly increased in patients with CSPH compared with patients without CSPH (P < .0001). HVPG correlated significantly with vWF-Ag (r = 0.64; P < .0001) and was able to predict CSPH independently of Child Pugh score. Using a vWF-Ag cutoff value of ≥241% the area under the curve (AUC) for detection of CSPH was 0.88 with a positive predictive value of 93% and a negative predictive value of 54%. Higher vWF-Ag levels were significantly associated with varices (odds ratio [OR], 3.27; P < .001), ascites (OR, 3.93; P < .001), and mortality (OR, 2.61; P < .0001). vWF-Ag equals the Model for End-Stage Liver Disease (MELD) score in mortality prediction (area under the receiver operating characteristic curve = 0.71 for vWF-Ag vs 0.65 for MELD; P = .2). Kaplan–Meier analysis shows the survival benefit for patients with vWF-Ag to be <324%. ConclusionAmong patients with liver cirrhosis, vWF-Ag is elevated and can discriminate between patients with CSPH and those without with a cutoff vWF-Ag of ≥241%. Further, vWF-Ag is a simple new marker for mortality prediction in patients with liver cirrhosis. Among patients with liver cirrhosis, vWF-Ag is elevated and can discriminate between patients with CSPH and those without with a cutoff vWF-Ag of ≥241%. Further, vWF-Ag is a simple new marker for mortality prediction in patients with liver cirrhosis.