title: The VITRO Score (Von Willebrand Factor Antigen/Thrombocyte Ratio) as a New Marker for Clinically Significant Portal Hypertension in Comparison to Other Non-Invasive Parameters of Fibrosis Including ELF Test.
abstract: BACKGROUND
  Clinically significant portal hypertension (CSPH), defined as hepatic venous pressure gradient (HVPG) ≥10 mmHg, causes major complications. HVPG is not always available, so a non-invasive tool to diagnose CSPH would be useful. VWF-Ag can be used to diagnose. Using the VITRO score (the VWF-Ag/platelet ratio) instead of VWF-Ag itself improves the diagnostic accuracy of detecting cirrhosis/ fibrosis in HCV patients.
  
  
  OBJECTIVE
  This study tested the diagnostic accuracy of VITRO score detecting CSPH compared to HVPG measurement.
  
  
  METHODS
  All patients underwent HVPG testing and were categorised as CSPH or no CSPH. The following patient data were determined: CPS, D'Amico stage, VITRO score, APRI and transient elastography (TE).
  
  
  RESULTS
  The analysis included 236 patients; 170 (72%) were male, and the median age was 57.9 (35.2-76.3; 95% CI). Disease aetiology included ALD (39.4%), HCV (23.4%), NASH (12.3%), other (8.1%) and unknown (11.9%). The CPS showed 140 patients (59.3%) with CPS A; 56 (23.7%) with CPS B; and 18 (7.6%) with CPS C. 136 patients (57.6%) had compensated and 100 (42.4%) had decompensated cirrhosis; 83.9% had HVPG ≥10 mmHg. The VWF-Ag and the VITRO score increased significantly with worsening HVPG categories (P<0.0001). ROC analysis was performed for the detection of CSPH and showed AUC values of 0.92 for TE, 0.86 for VITRO score, 0.79 for VWF-Ag, 0.68 for ELF and 0.62 for APRI.
  
  
  CONCLUSIONS
  The VITRO score is an easy way to diagnose CSPH independently of CPS in routine clinical work and may improve the management of patients with cirrhosis.
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine IV, Elisabeth Hospital, Linz, Austria.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hametner
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine III, Medical University Vienna, Austria.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine III, Medical University Vienna, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine III, Medical University Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Etschmaier
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine IV, Elisabeth Hospital, Linz, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schöfl
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine IV, Elisabeth Hospital, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ziachehabi
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Internal Medicine IV, Elisabeth Hospital, Linz, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Maieron
mesh_terms: D000368:Aged; D015415:Biomarkers; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014841:von Willebrand Factor