Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
J Gastroenterol. 2020 May;55(5):533-542. doi: 10.1007/s00535-019-01656-9. Epub 2019 Dec 12.
The ratio of von Willebrand Factor to platelets (VITRO) reflects the severity of fibrosis and portal hypertension and might thus hold prognostic value.
Patients with compensated cirrhosis were recruited. VITRO, Child-Pugh score (CPS) and MELD were determined at study entry. Hepatic decompensation was defined as variceal bleeding, ascites or hepatic encephalopathy. Liver transplantation and death were recorded.
One hundred and ninety-four patients with compensated cirrhosis (CPS-A 89%, B 11%; 56% male; median age 56 years; 50% with varices) were included. During a median follow-up of 45 months (IQR 29-61), decompensation occurred in 35 (18%) patients and 14 (7%) patients deceased. The risk of hepatic decompensation was significantly increased in the n = 88 (45%) patients with a VITRO ≥ 2.5 (p < 0.001). Patients with a VITRO ≥ 2.5 had a higher probability of decompensation at 1-year 9% (95% CI 3-16) vs. 0% (95% CI 0-0) and at 2-years 18% (95% CI 10-27%), vs. 4% (95% CI 0-8%) as compared to patients with VITRO < 2.5. Patients with VITRO ≥ 2.5, the estimated 1-year/2-year survival rates were at 98% (95% CI 95-100%) and 94% (95% CI 88-99%) as compared to 100% (95% CI 100-100%) both in the patients with a VITRO < 2.5 (p < 0.001). After adjusting for age, albumin and MELD, VITRO ≥ 2.5 remained as significant predictor of transplant-free mortality (HR 1.38, CI 1.09-1.76; p = 0.007). Patients with compensated cirrhosis and VITRO > 2.1 after hepatitis C eradication remained at significantly increased risk for decompensation (p = 0.033).
VITRO is a valuable prognostic tool for estimating the risk of decompensation and mortality in patients with compensated cirrhosis-including the setting after hepatitis C eradication.
血管性血友病因子与血小板比值（VITRO）反映了纤维化和门静脉高压的严重程度，因此可能具有预后价值。
招募了代偿性肝硬化患者。在研究开始时确定 VITRO、Child-Pugh 评分（CPS）和 MELD。肝失代偿定义为静脉曲张出血、腹水或肝性脑病。记录肝移植和死亡。
共纳入 194 例代偿性肝硬化患者（CPS-A 89%，B 11%；56%为男性；中位年龄 56 岁；50%有静脉曲张）。在中位随访 45 个月（IQR 29-61）期间，35 例（18%）患者发生肝失代偿，14 例（7%）患者死亡。在 n=88（45%）VITRO≥2.5 的患者中，肝失代偿的风险显著增加（p<0.001）。VITRO≥2.5 的患者在 1 年时发生失代偿的概率为 9%（95%CI 3-16），而 VITRO<2.5 的患者为 0%（95%CI 0-0），在 2 年时发生失代偿的概率为 18%（95%CI 10-27%），而 VITRO<2.5 的患者为 4%（95%CI 0-8%）。VITRO≥2.5 的患者 1 年/2 年的估计生存率分别为 98%（95%CI 95-100%）和 94%（95%CI 88-99%），而 VITRO<2.5 的患者为 100%（95%CI 100-100%）（均 p<0.001）。在校正年龄、白蛋白和 MELD 后，VITRO≥2.5 仍然是无移植死亡率的显著预测因素（HR 1.38，95%CI 1.09-1.76；p=0.007）。丙型肝炎病毒根除后 VITRO>2.1 的代偿性肝硬化患者失代偿风险显著增加（p=0.033）。
VITRO 是一种评估代偿性肝硬化患者（包括丙型肝炎病毒根除后的患者）失代偿和死亡率风险的有价值的预后工具。
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