Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2022; 14(4): 812-826
Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.812
Prognostic value of von-Willebrand factor in patients with liver cirrhosis and its relation to other prognostic indicators
Elena Curakova Ristovska, Magdalena Genadieva-Dimitrova
Elena Curakova Ristovska, Intensive Care Unit, University Clinic for Gastroenterohepatology, Skopje 1000, North Macedonia
Elena Curakova Ristovska, Magdalena Genadieva-Dimitrova, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje 1000, North Macedonia
Magdalena Genadieva-Dimitrova, Hepatology Department, University Clinic for Gastroenterohepatology, Skopje 1000, North Macedonia
Author contributions: Curakova Ristovska E contributed to study concept and design, acquisition of data, analysis, and interpretation of data and was responsible for the integrity of the work as a whole; Genadieva-Dimitrova M contributed to the critical revision of the manuscript and supervision.
Institutional review board statement: The research was reviewed and approved by the ethical comities for human research of the Medical Faculty, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia.
Informed consent statement: All patients that participated in the research signed an informed consent form for participation in the study.
Conflict-of-interest statement: The author declares that there is no conflict of interest regarding the publication of this paper.
Data sharing statement: All relevant data are available within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elena Curakova Ristovska, MD, PhD, Assistant Professor, Doctor, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Mother Teresa 17, Skopje 1000, North Macedonia. elenacurakova@yahoo.com
Received: June 9, 2021
Peer-review started: June 9, 2021
First decision: July 6, 2021
Revised: July 18, 2021
Accepted: March 7, 2022
Article in press: March 7, 2022
Published online: April 27, 2022
Processing time: 316 Days and 15.8 Hours
Abstract
BACKGROUND

Von-Willebrand factor (vWF) disposes certain prognostic value in patients with liver cirrhosis, but its relation to other prognostic indicators has not been fully investigated.

AIM

To analyze the relation between vWF and other prognostic indicators in cirrhotic patients and to evaluate its prognostic value for mortality.

METHODS

This analytic prospective study was carried out in a tertiary center and initially enrolled 71 patients with liver cirrhosis and portal hypertension. It analyzed the relation between vWF and the stage of the disease and several inflammatory and prognostic indicators. The prospective analysis, performed on a sample of 63 patients, evaluated the association between the selected variables [vWF, Model for End-stage Liver Disease (MELD) score, C-reactive protein (CRP), ferritin, vitamin D, activated partial thromboplastin time, thrombin time, D-dimer concentration] and the survival time as well as their predictive value in terms of 3-mo, 6-mo and 1-year mortality.

RESULTS

vWF was significantly higher in patients with higher Child-Turcotte-Pugh class (P = 0.0045), MELD group (P = 0.0057), ferritin group (P = 0.0278), and D-dimer concentration (P = 0.0232). vWF significantly correlated with D-dimer concentration, ferritin, CRP, International Normalized Ratio, and MELD, Child-Turcotte-Pugh, Sequential Organ Failure Assessment, and CLIF-consortium organ failure (CLIF-C OF) scores. vWF, MELD score, and CRP were significantly associated with death and were significant predictors of 3-mo, 6-mo, and 1-year mortality. Each vWF unit significantly increased the probability for 3-mo mortality by 1.005 times (P = 0.008), for 6-mo mortality by 1.006 times (P = 0.005), and for 1-year mortality by 1.007 times (P = 0.002). There was no significant difference between the diagnostic performance of vWF and MELD score and also between vWF and CRP regarding the 3-mo, 6-mo, and 1-year mortality.

CONCLUSION

In patients with liver cirrhosis, vWF is significantly related to other prognostic indicators and is a significant predictor of 3-mo, 6-mo, and 1-year mortality similar to MELD score and CRP.

Keywords: von-Willebrand factor; Cirrhosis; Mortality; C-reactive protein; D-dimer

Core Tip: The prognostic value of von-Willebrand factor (vWF) in cirrhotic patients has been previously evaluated, but its relation to other inflammatory and prognostic indicators has not been fully investigated. The study confirmed that vWF was significantly associated with the stage of liver disease, D-dimer concentration, ferritin, and survival and that vWF was a significant predictor of 3-mo, 6-mo, and 1-year mortality similar to Model for End-stage Liver Disease score and C-reactive protein. These data reflect the important prognostic role of the complex and dynamic interaction between endothelial dysfunction, systemic inflammation, and cirrhosis-related coagulopathy in cirrhotic patients.