Reliability of Plasma Von Willebrand Factor Antigen in Prediction of Esophageal Varices in Patients with Liver Cirrhosis

Hasan Sedeek Mahmoud^1*, Ali A. Ghweil¹, Shamardan E. Bazeed¹, Hanan M. Fayed², Mona M. Abdel Meguid²

¹Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena, Egypt.
²Department of Clinical Pathology, Faculty of Medicine, South Valley University, Qena, Egypt.

DOI: 10.4236/ojgas.2015.56010                

Abstract

Background: Bleeding esophageal varices (OVs) due to portal hypertension are one of the major complications with high mortality in liver cirrhosis. So, early detection and management are mandatory. Aim: To evaluate the role of Von Willebrand factor (VWF) in predicting the presence of OVs. Patients and Methods: 62 patients with liver cirrhosis representing different Child-Pugh classes were included. The diagnosis of liver cirrhosis was based on the combination of clinical, laboratory and US examinations. All included patients underwent the following investigations: complete blood count, liver function tests (ALT, AST, serum bilirubin, albumin and total protein, prothrombin time (PT) and concentration (PC), INR and serum alkaline phosphatase), serum creatinine, Von Willebrand factor antigen (VWF-Ag) measurement and abdominal US. Upper endoscopic evaluation was done to detect presence or absence of varices (esophageal or gastric) and/or PHG. Results: 38 males and 24 females with their mean age (46 ± 12 years old) were included. Plasma Von Willebrand factor-Ag level was significantly higher in patients with OVs than those without varices (P value = 0.000). Also, its level was significantly higher in patients with higher grade of OVs, G3 than those with G1 or G2 (P value = 0.000). Patients with large OVs including those with G2 and G3 showed significantly higher values of VWF than those with small OVs (NO and G1) (P value = 0.000). VWF was independent predictor for detecting the presence of OVs with good sensitivity (90), specificity (77.3) and accuracy (85.5) at a cutoff value of 1.74 U/ml. Also it was an independent predictor for detecting the presence of large OVs with good sensitivity (91.2), specificity (85.7) and accuracy (88.7) at a cutoff value of 2.16 U/ml. Conclusion: VWF-Ag could be used as a non invasive laboratory independent predictor for the detection of OVs.

Keywords

Von Willebrand Factor Antigen, Esophageal Varices, Prediction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bosch, J. and García-Pagán, J.C. (2000) Complications of Cirrhosis. I. Portal Hypertension. Journal of Hepatology, 32, 141-156. http://dx.doi.org/10.1016/S0168-8278(00)80422-5
[2]	Arguedas, M.R., Heudebert, G.R., Eloubeidi, M.A., Abrams, G. and Fallon, M.B. (2002) Cost-Effectiveness of Screening, Surveillance, and Primary Prophylaxis Strategies for Esophageal Varices. American Journal of Gastroenterology, 97, 2441-2452. http://dx.doi.org/10.1111/j.1572-0241.2002.06000.x
[3]	La Mura, V., Reverter, J.C., Flores-Arroyo, A., et al. (2011) Von Willebrand Factor Levels Predict Clinical Outcome in Patients with Cirrhosis and Portal Hypertension. Gut, 60, 1133-1138. http://dx.doi.org/10.1136/gut.2010.235689
[4]	Sadler, J.E., Mannucci, P.M., Berntorp, E., Bochkov, N., Boulyjenkov, V., Ginsburg, D., et al. (2000) Impact, Diagnosis and Treatment of Von Willebrand Disease. Thrombosis and Haemostasis, 84, 160-174.
[5]	Reiner, A.P., Siscovick, D.S. and Rosendaal, F.R. (2001) Hemostatic Risk Factors and Ar-terial Thrombotic Disease. Thrombosis and Haemostasis, 85, 584-595.
[6]	Wanless, I.R., Wong, F., Blendis, L.M., Greig, P., Heathcote, E.J. and Levy, G. (1995) Hepatic and Portal Vein Thrombosis in Cirrhosis: Possible Role in Development of Parenchymal Extinction and Portal Hypertension. Hepatology, 21, 1238-1247.
[7]	Yilmaz, V.T., Dincer, D., Avci, A.B. and Cetinkaya, R. (2015) Significant Association between Serum Levels of Von Willebrand Factor (vWF) Antigen with Stages of Cirrhosis. Eurasian Journal of Medicine, 47, 21-25. http://dx.doi.org/10.5152/eajm.2014.0016
[8]	Ferlitsch, M., Reiberger, T., Hoke, M., Salzl, P., Schwengerer, B., Ulbrich, G., Payer, B.A., Trauner, M., Peck-Radosavljevic, M. and Ferlitsch, A. (2012) Von Willebrand Factor as New Noninvasive Predictor of Portal Hypertension, Decompensation and Mortality in Patients With Liver Cirrhosis. Hepatology, 56, 1439-1447. http://dx.doi.org/10.1002/hep.25806
[9]	Beppu, K., Inokuchi, K., Koyanagi, N., et al. (1981) Prediction of Variceal Haemorrhage by Oesophageal Endoscopy. Gastrointestinal Endoscopy, 27, 213-218. http://dx.doi.org/10.1016/S0016-5107(81)73224-3
[10]	Paunescu, V., Grigorean, V. and Popescu, C. (2004) Risk Factors for Immediate Outcome of Gastrointestinal Bleeding in Patients with Cirrhosis. Chirurgia [Bucur], 99, 311-322.
[11]	Mahmoud, H.S., Mostafa, E.F. and Mohammed, M.A. (2014) Role of Portal Haemodynamic Parameters in Prediction of Oesophageal Varices in Cirrhotic Patients. Arab Journal of Gastroenterology, 15, 130-134. http://dx.doi.org/10.1016/j.ajg.2014.09.001
[12]	Ferro, D., Quintarelli, C., Lattuada, A., Leo, R., Alessandroni, M., Mannucci, P.M., et al. (1996) High Plasma Levels of Von Willebrand Factor as a Marker of Endothelial Perturbation in Cirrhosis: Relationship to Endotoxemia. Hepatology, 23, 1377-1383. http://dx.doi.org/10.1002/hep.510230613
[13]	Hollestelle, M.J., Geertzen, H.G., Straatsburg, I.H., van Gulik, T.M. and van Mourik, J.A. (2004) Factor VIII Expression in Liver Disease. Thrombosis and Haemostasis, 91, 267-275.
[14]	Lisman, T., Bongers, T.N., Adelmeijer, J., Janssen, H.L., de Maat, M.P., de Groot, P.G. and Leebeek, F.W. (2006) Elevated Levels of Von Willebrand Factor in Cirrhosis Support Platelet Adhesion despite Reduced Functional Capacity. Hepatology, 44, 53-61. http://dx.doi.org/10.1002/hep.21231
[15]	Wu, H., Yan, S., Wang, G., Cui, S., Zhang, C. and Zhu, Q. (2015) Von Willebrand Factor as a Novel Noninvasive Predictor of Portal Hypertension and Esophageal Varices in Hepatitis B Patients with Cirrhosis. Scandinavian Journal of Gastroenterology, 16, 1-10. http://dx.doi.org/10.3109/00365521.2015.1037346
[16]	Ghweil, A.A., Arafa, U.A., Khodeary, A. and Salem, A.N. (2014) Predictors of Bleeding from Esophageal Varices: The Role of Factor VII and Von Willebrand Factor (vWF). Open Journal of Gastroenterology, 4, 152-158. http://dx.doi.org/10.4236/ojgas.2014.44023