Von Willebrand factor tied to hepatic dysfunction, inflammation in advanced chronic liver disease

In the context of advanced chronic liver disease (ACLD), elevated levels of the von Willebrand factor antigen (VWF) appears to indicate disease progression, a recent study has found. VWF may also be used as a marker for hepatic dysfunction and systemic inflammation.

The study included 793 patients who showed evidence of ACLD on hepatic venous pressure gradient (HVPG) measurement. Participants were classified according to disease clinical stage (CS): probable compensated ACLD (cACLD: liver stiffness measurement ≥10 kPa, HVPG <6 mmHg), CS0 (cACLD with HVPG 6–9 mm Hg), CS1 (cACLD with HVPG >10 mm Hg), CS2 (cACLD with variceal bleeding), CS3 (cACLD with nonbleeding decompensation), and CS4 (≥2 decompensating events).

Levels of VWF, measured using an immune-turbidimetric assay, were substantially elevated (>420 percent) in 16 percent (n=124) of patients. This subgroup of patients had a median VWF of 533 percent. Of note, the proportion of those with elevated VFW increased with worsening disease severity (probable cACLD to CS0: 4 percent; CS1: 10 percent; CS2 to CS4: 23 percent; p≤0.001).

Moreover, in patients with elevated VWF, decompensated ACLD was significantly more common than in those with VWF <420 percent (78 percent vs 50 percent; p<0.001). VWF >420 percent patients likewise showed more advanced liver disease.

Spearman’s correlation analysis revealed that while VFW was not significantly correlated with HVPG (p=0.123), it was directly associated with C-reactive protein levels (p=0.001) and the model for end-stage liver disease (p<0.001), though at weak or moderate magnitudes.

“Quantification of substantially elevated VWF levels provides prognostic information on long-term outcomes in patients with ACLD, independently of established factors,” the researchers said.