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Plasma von Willebrand factor levels predict in-hospital survival in patients with acute-on-chronic liver failure

Prasanna, KS; Goel, A; Amirtharaj, GJ; Ramachandran, A; Balasubramanian, KA; Mackie, I; Zachariah, U; ... Eapen, CE; + view all (2016) Plasma von Willebrand factor levels predict in-hospital survival in patients with acute-on-chronic liver failure. Indian Journal of Gastroenterology , 35 (6) pp. 432-440. 10.1007/s12664-016-0708-2. Green open access

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Abstract

BACKGROUND AND AIMS: Circulating levels of von Willebrand factor (vWF) predict mortality in patients with cirrhosis. We hypothesized that systemic inflammation in acute-on-chronic liver failure (ACLF) will stimulate endothelium, increase vWF levels, and promote platelet microthrombi causing organ failure. METHODS: In this prospective study, we correlated plasma vWF levels with organ failure, liver disease severity, sepsis, and systemic inflammatory response syndrome (SIRS) and also analyzed if vWF levels predicted in-hospital composite poor outcome (i.e. death/discharged in terminal condition/liver transplantation) in consecutive ACLF patients. RESULTS: Twenty-one of the 50 ACLF patients studied had composite poor outcome. ACLF patients had markedly elevated vWF antigen and activity (sevenfold and fivefold median increase, respectively) on days 1 and 3. Median ratio of vWF to a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) activity on day 1 was significantly higher in ACLF patients (11.2) compared to 20 compensated cirrhosis patients (3.3) and healthy volunteers (0.9). On day 1, area under ROC curve (AUROC) to predict composite poor outcome of hospital stay for ACLF patients for vWF antigen, vWF activity, and model for end-stage liver disease (MELD) score were 0.63, 0.68, and 0.74, respectively. vWF activity correlated better with liver disease severity (MELD score, ACLF grade) and organ failure (Sequential Organ Failure Assessment [SOFA] score) than vWF antigen; in contrast, neither vWF antigen nor activity correlated with platelet count, sepsis, or SIRS. CONCLUSIONS: vWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in ACLF patients. This data provides a mechanistic basis for postulating that vWF-reducing treatments such as plasma exchange may benefit ACLF patients.

Type: Article
Title: Plasma von Willebrand factor levels predict in-hospital survival in patients with acute-on-chronic liver failure
Location: India
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s12664-016-0708-2
Publisher version: http://doi.org/10.1007/s12664-016-0708-2
Language: English
Additional information: © Indian Society of Gastroenterology 2016. The final publication is available at Springer via http://dx.doi.org/10.1007/s12664-016-0708-2
Keywords: ADAMTS13, Endothelial activation, Von Willebrand factor
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Haematology
URI: https://discovery.ucl.ac.uk/id/eprint/1529636
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