Asada Shohei, Namisaki Tadashi, Kaji Kosuke, Takaya Hiroaki, Kubo Takahiro, Akahane Takemi, Kawaratani Hideto, Nishimura Norihisa, Takeda Soichi, Masuda Hiroyuki, Shibamoto Akihiko, Inoue Takashi, Iwai Satoshi, Tomooka Fumimasa, Tsuji Yuki, Fujinaga Yukihisa, Kitagawa Koh, Mitoro Akira, Sato Shinya, Matsumoto Masanori, Yoshiji Hitoshi
Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
Department of Evidence-Based Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
Dig Dis Sci. 2024 Mar;69(3):851-869. doi: 10.1007/s10620-023-08257-w. Epub 2024 Jan 20.
We investigated the von Willebrand factor to ADAMTS13 ratio (von Willebrand factor [VWF]:Ag/ADAMTS13:AC) as a potential biomarker for the outcomes of acute kidney injury (AKI) in liver cirrhosis (LC).
This retrospective cross-sectional study included patients with LC who developed AKI (AKI group: n = 91) and patients with LC who did not develop AKI [non-AKI (NAKI) group, n = 91] as a control group. Plasma levels of the von Willebrand factor antigen (Ag) and ADAMTS13 activity (AC) were measured in patients with AKI or NAKI. Moreover, risk factors for onset of AKI, AKI-associated 90-day mortality, and poor AKI treatment response were identified.
The AKI group had a significantly higher VWF:Ag/ADAMTS13:AC than the NAKI group. Values of VWF:Ag/ADAMTS13:AC ≥ 5.7 were identified as risk factors for AKI onset in patients with LC (odds ratio [OR] 2.56; 95% CI 1.26-4.99; p < 0.001). Among patients with AKI, values of VWF:Ag/ADAMTS13:AC ≥ 9.0 were identified as risk factors for 90-day mortality (OR 6.83; 95% CI 2.32-20.10; p < 0.001). Cumulative survival was significantly lower in those with high (≥ 9.0) than in those with low (< 9.0) VWF:Ag/ADAMTS13:AC. Furthermore, values of VWF:Ag/ADAMTS13:AC ≥ 7.4 were identified as risk factors for poor treatment response (OR 4.2; 95% CI 1.39-12.70; p < 0.001). The treatment response rates were significantly higher in those with low (< 7.4) VWF:Ag/ADAMTS13:AC than in those with high (≥ 7.4) VWF:Ag/ADAMTS13:AC.
VWF:Ag/ADAMTS13:AC potentially predicts the onset, prognosis, and treatment response of AKI in patients with LC.
我们研究血管性血友病因子与ADAMTS13的比值（血管性血友病因子[VWF]:抗原/ADAMTS13:活性）作为肝硬化（LC）患者急性肾损伤（AKI）预后的潜在生物标志物。
这项回顾性横断面研究纳入了发生AKI的LC患者（AKI组：n = 91）和未发生AKI的LC患者[非AKI（NAKI）组，n = 91]作为对照组。对AKI或NAKI患者测定血浆血管性血友病因子抗原（Ag）水平和ADAMTS13活性（AC）。此外，还确定了AKI发病的危险因素、与AKI相关的90天死亡率以及AKI治疗反应不佳的危险因素。
AKI组的VWF:Ag/ADAMTS13:AC显著高于NAKI组。VWF:Ag/ADAMTS13:AC≥5.7的值被确定为LC患者发生AKI的危险因素（比值比[OR]2.56；95%置信区间1.26 - 4.99；p < 0.001）。在AKI患者中，VWF:Ag/ADAMTS13:AC≥9.0的值被确定为90天死亡率的危险因素（OR 6.83；95%置信区间2.32 - 20.10；p < 0.001）。VWF:Ag/ADAMTS13:AC高（≥9.0）的患者累积生存率显著低于低（<9.0）的患者。此外，VWF:Ag/ADAMTS13:AC≥7.4的值被确定为治疗反应不佳的危险因素（OR 4.2；95%置信区间1.39 - 12.70；p < 0.001）。VWF:Ag/ADAMTS13:AC低（<7.4）的患者治疗反应率显著高于高（≥7.4）的患者。
VWF:Ag/ADAMTS13:AC可能预测LC患者AKI的发病、预后及治疗反应。
