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Von Willebrand factor levels predict clinical outcome in patients with cirrhosis and portal hypertension

Von Willebrand factor levels correlate with liver function and HVPG and independently predict clinical outcome in patients with cirrhosis and portal hypertension, reports August's issue of Gut.

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Endothelial dysfunction is a major determinant of the increased hepatic vascular tone of cirrhotic livers.

Von Willebrand factor, P-selectin and 8-iso-PGF2α (isoprostanes), surrogate markers of endothelial dysfunction, are increased in patients with cirrhosis.

Dr Juan Carlos García-Pagán and colleagues from Spain explored in patients with cirrhosis and portal hypertension the relation of these endothelial factors with systemic and hepatic haemodynamics and their possible clinical prognostic value.

The researchers found 42 consecutive patients with cirrhosis and portal hypertension had measurement of the hepatic venous pressure gradient, cardiopulmonary pressures and Von Willebrand factor, P-selectin and isoprostane levels in blood samples from hepatic and peripheral veins.

Patients were followed up to 2 years, death or liver transplantation and any clinical event were recorded.
11 markers provided independent prognostic or predictive information
Gut

Von Willebrand factor, P-selectin and isoprostanes were increased in patients with cirrhosis compared with controls.

The researchers found that Von Willebrand factor levels significantly correlated with hepatic venous pressure gradient, Child–Pugh score and MELD.

Cox model analysis disclosed an independent indirect association of peripheral Von Willebrand factor with survival free of portal hypertension-related events and of transplantation.

The team found that the Von Willebrand factor cut-off value of 216 U/dl disclosed 2 different populations of patients with cirrhosis with a highly different probability of survival free of portal hypertension-related events and transplantation.

The research team observed that the prognostic role of Von Willebrand factor persisted after adjusting for parameters of liver dysfunction and for HVPG.

Dr García-Pagán's team concluded, "In patients with cirrhosis and portal hypertension Von Willebrand factor levels correlate with liver function and HVPG and independently predict clinical outcome."

Gut 2011; 60: 1133-1138
15 July 2011

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