Predictive and Prognostic Value of Von Willebrand Factor in Patients with Cirrhosis and Esophageal Varices

Abstract

Background and study aim: Von Willebrand factor (vWF) is released by activated endothelial cells and plays a crucial role in the development of portal hypertension. vWF levels correlate with liver function and venous hepatic pressure gradient (VHPG) and independently predict clinical outcome. The aim was to evaluate serum vWF levels as a predictor for esophageal varices and prognosis in patients with liver cirrhosis.Patients and Methods: Sixty two patients with liver cirrhosis, divided into two groups according to presence (group I) or absence (group II) of varices were included, In addition, twenty healthy persons served as control group (group III). All patients were submitted to full history taking, clinical examination, laboratory investigations and abdominal ultrasonography. The severity of liver disease was estimated by Modified Child-Pugh and Model for End Stage Liver Disease (MELD) scores. All patients were underwent upper gastrointestinal endoscopy and vWF assay.Results: vWF values were significantly higher in group I (p1=0.001), than controls (p2=0.000), but no significant difference between group II and control group (p3= 0.59). Receiver operating characteristics (ROC) curve analysis of vWF revealed that, vWF at cutoff value of 173.8 µg/ml; the sensitivity for detection of esophageal varices was 80.8%, specificity 76.0%, positive predictive value (PPV) was 93.9%, negative predictive value (NPV) was 55.6%; area under the curve was 86.6.There was significant positive correlation between vWF and Child, MELD, esophageal varices grade and severity of portal hypertensive gastropathy. Conclusion:vWF is a good predictor for development of esophageal varices and correlated well with prognosis in patients with cirrhosis.

Evaluation of serum kallistatin level as a predictor of esophageal varices in cirrhotic patients

“…This agrees with Tafarel et al [19], who found that the presence of esophageal varices is not affected by age, gender, or type of chronic viral hepatitis. This also agrees with Eltoukhy and Issa [20], who found that the presence of varices is not affected by the type of viral hepatitis or the history of bilharziasis. This also agrees with AbdelMaksoud et al [21], who found that there were no significant differences as regards age, gender, viral hepatitis, or bilharziasis between cirrhotic patients with and without varices.…”

Von Willebrand Factor; a New Non-Invasive Marker for Assessment of Liver Fibrosis in Infants and Children

“…This came in agreement with El-Toukhy and Issa (21) who conducted their study on sixty two patients with liver cirrhosis, divided into two groups according to presence (group I) or absence (group II) of varices. In addition, twenty healthy persons served as control group (group III).They displayed that, Receiver operating characteristics (ROC) curve analysis of vWF revealed that, vWF at cutoff value of 173.8 μg/ml; the sensitivity for detection of esophageal varices was 80.8%, specificity 76.0%, positive predictive value (PPV) was 93.9%, negative predictive value (NPV) was 55.6%; area under the curve was 86.6.…”

“…In the same line, El-Toukhy and Issa (21) demonstrated that, vWF is a good predictor for the development as well as the prognosis in patients with cirrhosis.…”

“…Similarly, El-Toukhy and Issa (21) displayed that; there was a significant positive correlation between vWF and Child as well as MELD scores.…”