Role of the von Willebrand factor and the VITRO score as predictors for variceal bleeding in patients with hepatitis C-related cirrhosis

Abstract

Background Noninvasive methods have been established to detect clinically significant portal hypertension in liver cirrhosis with variable limitations. The von Willebrand factor (vEF) has been found to increase in liver cirrhosis. Aim The aim of this study was to explore the vEF and VITRO (von Willebrand factor antigen/platelet ratio) score in the prediction of variceal bleeding in patients with portal hypertension. Materials and methods Fifty patients with hepatitis C-related liver cirrhosis (25 patients with variceal bleeding and 25 without variceal bleeding) as well as 80 healthy controls were included. Laboratory investigations and upper gastrointestinal endoscopy were performed in all patients. Serum vEF was measured in the patient and the control group. The VITRO score was calculated. Results The mean levels of the vEF antigen and the VITRO score were higher in patients with variceal bleeding compared with patients without variceal bleeding and controls (P<0.001). At levels of at least 100.1 ng/ml and at least 0.732, the vEF and the VITRO score could predict variceal bleeding with a sensitivity and a specificity of 92 and 99.9% for the vEF and 80 and 68% for the VITRO score (area under the curve=0.982 and 0.843), respectively. Levels of vEF were correlated positively with esophageal varices grade. Conclusion Serum vEF level and the VITRO score are potential noninvasive biomarkers for the prediction and risk stratification of variceal bleeding in hepatitis C-related liver cirrhosis.

Role of Plasma Von Willebrand Factor-Antigen in predicting the presence of Esophageal Varices and occurrence of its bleeding in cirrhotic patients

“…The multivariate analysis for possible confounding factors revealed that VWF was independently correlated to the esophageal varices and that none of these variables correlated to the VWF confounded its relation to the esophageal varices. This comes in agreement with Ibrahim et al [19] who found that VWF is an independent predictor of variceal bleeding [19].…”

“…In our study we found that the VITRO score was significantly higher among patients of group I than in group II. This agrees with Hassan et al[18] and Ibrahim et al[19] who said that the VITRO score was significantly higher in patients with varices[18,19]. This may be the reason that the association between VWF and the hepatic decompensation was not clear in study.…”

Primary Hemostasis in Chronic Liver Disease and Cirrhosis: What Did We Learn over the Past Decade?

“…No association was observed between platelet count and bleeding. Two studies addressing variceal bleeding found opposite results regarding the association between platelet count and bleeding [20,21]. It is, however, important to stress that platelet count may merely reflect the degree of portal hypertension responsible for variceal hemorrhage [22].…”

Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency

“…A decade ago, researchers tried to exploit metabolic data to predict HVPG and found that the homeostasis model assessment index was associated with high risk of EVB[ 15 ]. Ibrahim et al [ 16 ] reported that the serum vWF antigen level and vWF antigen/platelet ratio (VITRO) could help stratify the risk of bleeding, with AUCs of 0.982 and 0.843, respectively, although this study had a small sample size. Kothari et al [ 17 ] argued that the platelet count-to-spleen diameter ratio and FIB-4 index might be useful for predicting EVB, with AUCs of 0.78 and 0.74, respectively.…”