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

Abstract

Background: Von Willebrand Factor (vWF) is a multimeric adhesive protein to which platelets stick. It is physiologically released by activated endothelial cells during primary hemostasis. High Shear stress induced by hyperdynamic (splanchnic) circulation in advanced hepatic fibrosis as well as endotoxinemia caused by bacterial translocation may contribute to the increased levels of vWF releasing from that activated endothelium. Objective: The aim of the current work was to assess the stage of fibrosis changes in children with CLD noninvasively by measuring the levels of serum Vwf Ag. Patients and Methods: This was an observational case control study conducted on sample of 40 infants and children up to 18 years divided into two equal groups of 20 cases (fibrotic) attending hepatic clinic at Mansoura University Children' Hospital and another 20 healthy matched controls. The diagnosis of fibrosis was previously verified by clinical, biochemical, ultrasonographic criteria and biopsy. Results: There was highly statistically significant increase in vWF value in the cases compared to the controls (167.1  47.8 Vs 112.9  36.1 IU/dL) (P<0.001). vWF Ag values demonstrated insignificant differences concerning etiology of liver disease, presence or absence of ascites and hepatosplenomegaly (P>0.05). Values of vWF Ag were demonstrated to be significantly increases in cases with severe fibrosis as well as cases with varices (P<0.05). There were highly statistically significant correlations between vWF Ag level and both fibrosis stage and Child Score among the studied patients (P≤0.001). Conclusion:It could be concluded Willebrand factor antigen level was positively correlated with liver function tests as well as varices and could be used as a significant predictor to severity of liver fibrosis and / or cirrhosis in children and infants with chronic liver disease.