title: von Willebrand factor as a novel noninvasive predictor of portal hypertension and esophageal varices in hepatitis B patients with cirrhosis.
abstract: OBJECTIVE
  At present, there is no perfect noninvasive method to assess portal hypertension and esophageal varices. Early predicting esophageal varices can provide evidence for managing cirrhotic patients. We aimed to further investigate von Willebrand factor (vWF) as a noninvasive predictor of portal hypertension, especially of esophageal varices.
  
  
  METHODS
  A total of 60 hepatitis B patients with cirrhosis and 45 healthy subjects were enrolled in this study. Levels of six markers were examined. All patients underwent hepatic venous pressure gradient (HVPG) and esophagogastroduodenoscopy. We evaluated the performance of six factors for diagnosis of portal hypertension and esophageal varices. The vWF levels in liver tissues were observed by immunohistochemistry. Correlations between the level of vWF in liver tissues and HVPG and between levels of vWF in tissues and plasma were examined.
  
  
  RESULTS
  Cutoff values of plasma vWF (1510.5 mU/mL and 1701 mU/mL) showed high positive predictive value (PPV, 90.2% and 87.5%) in predicting clinically significant portal hypertension and severe portal hypertension. Cutoff values of vWF (1414 mU/ml and 1990 mU/mL, PPV 90.3% and 86.3%, respectively) were provided to detect the presence and degree of esophageal varices. Linear correlations were observed between levels of vWF in liver tissues and HVPG (r(2) = 0.552, p < 0.001) and between the level of vWF in liver tissues and in plasma (r(2) = 0.461, p < 0.001).
  
  
  CONCLUSIONS
  The vWF is a noninvasive predictor of portal hypertension and esophageal varices in hepatitis B patients with cirrhosis. Increased levels of vWF in liver tissues may induce the elevated plasma vWF levels, but molecular mechanism is needed for further study.
authors: Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University , Jinan, Shandong , China.
authors: Hao
authors: H
authors: Wu
authors: Shiping
authors: S
authors: Yan
authors: Guangchuan
authors: G
authors: Wang
authors: Shaobo
authors: S
authors: Cui
authors: Chunqing
authors: C
authors: Zhang
authors: Qiang
authors: Q
authors: Zhu
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014841:von Willebrand Factor / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014841:von Willebrand Factor
keywords: Esophageal varices; liver cirrhosis; noninvasive predictor; portal hypertension; von Willebrand factor