Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.812
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
Endothelial dysfunction (ED) and systemic inflammation (SI) play an important role in the pathogenesis of portal hypertension (PH). Von-Willebrand factor (vWF) is an indicator of ED that favors a prothrombotic state, and hence it is directly involved in the progression of PH. Although previous research confirmed its prognostic value in cirrhotic patients, its relation to other prognostic indicators has not been properly evaluated. By analyzing the relation between vWF and other biological variables with certain prognostic potential, our research provides an insight into the complex relation between ED, SI, and liver-disease related coagulopathy in cirrhotic patients.
Although Model for End-stage Liver Disease (MELD) score is the most widely used prognostic score in cirrhotic patients, it does not take into account the presence of circulatory dysfunction or SI and it does not assess the coagulopathy properly. This raises the need for further research towards identifying new biological variables with certain prognostic potential in cirrhotic patients and evaluating their prognostic value for mortality. This could lead toward defining new prognostic scores or improve the predictive value of those currently in use. Recent researchers have suggested that some biological variables such as vWF, C-reactive protein (CRP), ferritin, and vitamin D possess certain prognostic potential in cirrhotic patients, but this area has not been widely investigated.
We tried to analyze the relation between vWF and liver cirrhosis and the relation between vWF and several inflammatory indicators and other variables that have certain prognostic potential in cirrhotic patients. We also tried to evaluate the prognostic value of vWF and several parameters in terms of 3-mo, 6-mo, and 1-year mortality.
We conducted an analytic prospective study that enrolled 71 patients with liver cirrhosis and portal hypertension. At enrollment, we performed detailed examinations (abdominal ultrasound, complete blood count, biochemical blood analysis, basic hemostasis, D-dimer, vWF concentration) in order to assess the stage of the liver disease after which we followed the patients for 1 year. We analyzed the relation between vWF and chronic liver disease and between vWF and several prognostic and inflammatory indicators. We prospectively evaluated the prognostic value of vWF and several other variables (MELD score, CRP, ferritin, vitamin D, activated partial thromboplastin time, thrombin time, D-dimer concentration) in terms of 3-mo, 6-mo, and 1-year mortality, and we compared the diagnostic efficacy of vWF for morality to other significant mortality predictors.
Our study confirmed a significant relation between vWF and the stage of liver disease, CRP, ferritin, and D-dimer concentration. The study also confirmed that in patients with liver cirrhosis vWF, MELD score, and CRP were significantly related to 3-mo, 6-mo, and 1-year survival and significant predictors of 3-mo, 6-mo, and 1-year mortality. Our study did not confirm a significant difference between the diagnostic performance for mortality of vWF and MELD score and between the diagnostic performance of vWF and CRP.
In patients with liver cirrhosis, vWF is a significant and relevant mortality predictor similar to MELD score and CRP, which highlights the important role of the ED in the pathogenesis of PH. Elevated CRP is a significant mortality predictor in patients with liver cirrhosis, which emphasizes the importance of recognizing the presence of SI for accurate mortality prediction. The relation between vWF and D-dimer concentration, ferritin, and CRP reflects the complex and dynamic interaction between ED, SI, and cirrhosis-related coagulopathy that occurs in patients with liver cirrhosis.
Future research should be focused on identifying specific clinical settings in which vWF would have more accurate prognostic value.