This journal club reviewed the recent Hepatology article by an Austrian group that looked at the diagnostic and prognostic potential of von Willebrand factor (vWF). They aimed to detect clinically significant portal hypertension (ie. HVPG >10mmHg); and to evaluate levels for the prediction of decompensation and mortality.
Two hundred eighty-six patients with cirrhosis were evaluated. Patients with clinically significant portal hypertension had mean vWF values higher than those with HVPG < 10mmHg. Looking at the results figure, however, there is significant overlap between the two groups, and therefore only the highest vWF levels (>315%) can reliably detect significant portal hypertension.
Higher vWF levels were associated with ascites, varices and mortality (HR 4.4). Using a cutoff of vWF of 315%, both compensated and decompensated patients lived longer when vWF was lower than this value. In fact, vWF levels had ROC values similar to that of the MELD score. This finding should be reassessed in a cohort where renal dysfunction, an influential component of the MELD score, is not excluded as was the case in this cohort.
vWF-Ag is a new, simple and noninvasive predictor of clinically significant portal hypertension. A vWF-Ag cut–off value at 315% can clearly stratify patients with com- pensated 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. It could be used in the hospital setting prior to surgery, or prior to TACE for HCC, when the clinician would want to know whether significant portal hypertension is present; this is similar to transient elastography, which is not as widely used or as practical.
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