Department of Blood Transfusion, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.
Can J Gastroenterol Hepatol. 2022 Mar 22;2022:9035971. doi: 10.1155/2022/9035971. eCollection 2022.
The model for end-stage liver disease (MELD) scoring system cannot be used to assess the deterioration of patients with liver cirrhosis caused by infection and portal hypertension. Elevated von Willebrand factor antigen (vWF-Ag) in plasma is associated with portal pressure and complications in patients with liver cirrhosis. We aimed to evaluate whether the addition of vWF-Ag can improve the risk prediction ability of the MELD scoring system.
A total of 228 patients with hepatitis B virus (HBV)-related liver cirrhosis were eligible for inclusion in this retrospective study. The vWF-Ag level was assessed by enzyme-linked immunosorbent assay (ELISA). The endpoint of this study was defined as the time to liver transplantation or death. Univariate and multivariate analyses were performed to assess the risk factors associated with transplant-free mortality. Receiver operating characteristic (ROC) curve analysis was used to assess potential discriminatory variables for transplant-free mortality.
During a median follow-up interval of 30.23 months, 124 patients (54.4%) reached the endpoint of this study. Patients who died or underwent liver transplantation had elevated levels of MELD and vWF-Ag. Moreover, vWF-Ag and MELD showed comparable predictive potential for transplant-free survival (area under the curve [AUC], vWF-Ag = 0.71; AUC, MELD = 0.73). Ultimately, vWF-Ag can significantly improve the predictive potential of MELD in determining transplant-free mortality (AUC, MELD-vWF-Ag = 0.79, = 0.006).
An elevated vWF-Ag level was independently associated with transplant-free mortality in patients with liver cirrhosis. The inclusion of vWF-Ag in the MELD scoring system can improve mortality predictions in patients with liver cirrhosis.
终末期肝病模型（MELD）评分系统不能用于评估由感染和门静脉高压引起的肝硬化患者的病情恶化。血浆中升高的血管性血友病因子抗原（vWF-Ag）与肝硬化患者的门静脉压力和并发症相关。我们旨在评估 vWF-Ag 的添加是否可以提高 MELD 评分系统的风险预测能力。
本回顾性研究共纳入 228 例乙型肝炎病毒（HBV）相关肝硬化患者。通过酶联免疫吸附试验（ELISA）评估 vWF-Ag 水平。本研究的终点定义为肝移植或死亡时间。进行单变量和多变量分析以评估与无移植死亡率相关的风险因素。使用接收者操作特征（ROC）曲线分析评估无移植死亡率的潜在鉴别变量。
在中位随访 30.23 个月期间，124 例患者（54.4%）达到了本研究的终点。死亡或接受肝移植的患者 MELD 和 vWF-Ag 水平升高。此外，vWF-Ag 和 MELD 对无移植生存率具有相当的预测潜力（曲线下面积 [AUC]，vWF-Ag=0.71；AUC，MELD=0.73）。最终，vWF-Ag 可以显著提高 MELD 预测无移植死亡率的能力（AUC，MELD-vWF-Ag=0.79，P=0.006）。
vWF-Ag 水平升高与肝硬化患者的无移植死亡率独立相关。在 MELD 评分系统中纳入 vWF-Ag 可以提高肝硬化患者的死亡率预测。
