The addition of von Willebrand factor to MELD scoring system improves prediction of short-term prognosis in liver cirrhosis

Abstract

Abstract: Objective To determine the relationship of plasma von Willebrand factor (vWF) level and the severity of liver cirrhosis and its predictive value when combined with the MELD scoring system in short-term prognosis. Methods A total of 234 cirrhotic patients who were hospitalized in Department of Infectious Diseases, Ruijin Hospital from September 2017 to March 2022 were initially enrolled. Plasma vWF:Ag levels were measured and clinical data were recorded. The correlations between plasma vWF:Ag level and MELD/MELD-Na scores were analyzed. Its predictive effect on 1-month and 3-month prognosis were evaluated. Results Plasma vWF:Ag levels were positively correlated with MELD and MELD-Na scores (r=0.576 and r=0.579, both P<0.01). Death／liver transplantation occurred in 16.7％(29/174) and 24.8％ (38/153) of patients at 1 and 3 months, respectively. Plasma vWF:Ag levels in higher mortality risk groups were both significantly higher than those in lower mortality risk groups (1 month, non-death/liver transplantation vs death/liver transplantation, 224.4±42.7％ vs 260.7±34.5%, P<0.01;3 months, non-death/liver transplantation vs death/liver transplantation, 219.0±40.3％ vs 262.5±34.2％, P<0.01). Multivariate analysis revealed that plasma vWF:Ag level was independently associated with 3-month death/liver transplantation (OR=1.026, 95％CI:1.006~1.046, P<0.01). Prediction of 3-month mortality risk was assessed by receiver operating characteristic curve (ROC-AUC). The diagnostic performance of MELD-Na score was slightly higher than those of MELD score and plasma vWF:Ag level in terms of 3-months outcome, which can be improved by of plasma vWF:Ag level incorporated into MELD-Na score as MELD-Na-vWF score (AUC:vWF:Ag, 0.795;MELD, 0.835;MELD-Na, 0.851;MELD-Na-vWF, 0.881). Conclusion Plasma vWF:Ag level increases with the severity of liver cirrhosis. vWF:Ag was an independent predictor of death／liver transplantation at 3 months. The addition of vWF-Ag to MELD-Na score improves prediction value.

Key words: von Willebrand Factor, Liver cirrhosis, Model for end-stage liver disease(MELD), Prognosis

ZHUANG Yan, LIN lan-yi. The addition of von Willebrand factor to MELD scoring system improves prediction of short-term prognosis in liver cirrhosis[J]. Chinese Hepatolgy, 2023, 28(7): 759-763.

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