A Novel, Noninvasive Marker for Portal Hypertension in Cirrhosis?
The von Willebrand factor antigen performed well in diagnosing portal hypertension and predicting decompensation outcomes and mortality in patients with cirrhosis.
Portal hypertension (hepatic venous pressure gradient [HVPG] 10 mm Hg) in patients with cirrhosis is associated with increased morbidity and mortality. Measurement of HVPG is expensive, invasive, and typically available only in specialized centers. Now, researchers have explored whether von Willebrand factor antigen (vWF-Ag) is a useful alternative indicator of portal hypertension.
Investigators enrolled 286 patients (72% men) with cirrhosis who were undergoing HVPG measurements at a single center in Austria and prospectively recorded hepatic decompensation outcomes and mortality every 6 months from patient exams and death registry data for approximately 2 years. vWF-Ag was assessed as a potential diagnostic indictor for portal hypertension and a predictor of decompensation and mortality. Fifty-two percent of patients were classified as Child-Pugh class A, 36% as class B, and 12% as class C.
Seventy-four percent of patients had an HVPG level 10 mm Hg, 66% of whom had HVPG 12 mm Hg. The vWF-Ag level correlated with HVPG level (r, 0.64; P<0.001), and increased levels of vWF-Ag were associated with increased risk for varices (odds ratio, 3.27; P<0.001), ascites (OR, 3.93; P<0.001), and mortality (hazard ratio, 4.41; P<0.001). A cutoff level of vWF-Ag 241% resulted in an area under the curve (AUC) of 0.85 to detect clinically significant portal hypertension, with positive and negative predictive values of 87% and 80%, respectively. A cutoff level of vWF-Ag 315% predicted mortality in both patients with compensated and decompensated cirrhosis. Furthermore, vWF-Ag level was equal to the model for end-stage liver disease (MELD) in predicting mortality (AUC, 0.71 and 0.65).
CITATION(S):
Ferlitsch M et al. von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis. Hepatology 2012 Oct; 56:1439.
