Title: Von Willibrand Factor Antigen as a Non Invasive Predictor of Portal Hypertension in Patients with Liver Cirrhosis
Authors: Mohamed Amin Mekkawy, Mona Fathey Abdel Fattah, Ahmed Ahmed Allam, Nehal Abdelfattah Elfawy Mahmoud
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.29
Abstract
In cirrhotic livers, increased resistance to portal blood flow is the primary factor in the pathophysiology of portal hypertension (PH) and is caused by structural abnormalities in the hepatic vascular architecture and an increased hepatic vascular tone. Von Willebrand factor antigen (vWF Ag) is released by activated endothelial cells (ECs) and therefore represents an indicator of EC activation and plays a crucial role in high shear stress, depending on primary hemostasis. The aim of this work was to evaluate the diagnostic performance of vWF-Ag to detect clinically significant PH suggested by portal vein velocity (PVV) in patients with liver cirrhosis and to evaluate vWF-Ag levels in the prediction of decompensation.
Patients and methods: vWF Ag was measured in thirty patients with liver cirrhosis and twenty healthy control subjects and results were correlated with portal hypertension as suggested by portal vein velocity.
Results: Levels of vWF Ag were significantly higher in patients with cirrhosis than healthy control subjects while levels of PVV were significantly lower. vWF Ag significantly increase in presence of ascites and shrunken liver. Levels of vWF show significant correlation with PVV and the best diagnostic cutoff value for portal hypertension was found to be 270 U/dL.
Conclusion: Our study shows an impressive correlation between portal hypertension and vWF levels thus can be used as noninvasive predictor of clinically significant portal hypertension (CSPH) in patients with liver cirrhosis.
Keywords: von Willebrand factor, portal hypertension, non invasive, cirrhosis.
References
1. Bertolani C and Marra F. The role of adipokines in liver fibrosis. Pathophysiology. 2008; 15(2): 91–101.
2. Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ and Sobin LH. The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. J Clin Pathol. 1978;31:395–414.
3. Friedman SL. Liver fibrosis: from bench to bedside. J. Hepatol. 2003; 38: 38–53.
4. El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology. 2004; 127: 27–34.
5. Bosch J and Garcia-Pagan JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol 2000; 32(1 Suppl): 141e56.
6. La Mura V, Reverter JC, Flores-Arroyo A, Raffa S, Reverter E and Seijo S. Von Willebrand factor levels predict clinical outcome in patients with cirrhosis and portal hypertension. Gut. 2011; 60: 1133-1138.
7. Iwakiri Y and Groszmann RJ. Vascular endothelial dysfunction in cirrhosis. J Hepatol. 2007;46:927e34.
8. Thabut D, Moreau R and Lebrec D. Non-invasive assessment of portal hypertension in patients with cirrhosis. HEPATOLOGY. 2011; 53: 683-694.
9. D’Amico G, Garcia-Tsao G and Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006; 44: 217-231.
10. Al-Nakshabandi N. The role of ultrasonography in portal hypertension. Saudi J Gastroenterol. 2006; 12: 111-7
11. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762-768.
12. Ferlitsch M, Reiberger T, Hoke M, Salzl P, Schwengerer B, Ulbrich G, Payer BA, Trauner M, Peck-Radosavljevic M, and Ferlitsch A. von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis. HEPATOLOGY. 2012; 56 (4): 1439-1447.
13. Spiel AO, Gilbert JC and Jilma B. von Willebrand factor in cardiovascular disease: focus on acute coronary syndromes. Circulation. 2008;117:1449e59.
14. Lisman T, Bongers TN, Adelmeijer J, Janssen HL, de Maat MP, de Groot PG and Leebeek FW. Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity. HEPATOLOGY. 2006; 44: 53-61.
15. Zaverio M and Ruggeri. The role of vWF in thrombus formation. Thrombosis Research. 2007; 120 (1): S5-S9.
16. Mendolicchio GL and Ruggeri ZM. New perspectives on von Willebrand factor function in hemostasis and thrombosis. Semin hematol. 2005 jan;42(1):5-14
17. Chawla Y, Santa N, Dhiman RK and Dilawari JB. Portal hemodynamics by duplex Doppler sonography in different grades of cirrhosis. Dig Dis Sci. 1998; 43 (2): 354-357.