von Willebrand factor and procoagulant imbalance predict outcome in patients with cirrhosis and thrombocytopenia.
Several lines of evidence suggest that the hemostatic disorders of cirrhosis may have a significant clinical impact. We investigated the independent predictive value of components of the hemostatic system on the occurrence of ascites, variceal bleeding (VB), and survival.



One hundred and two patients with thrombocytopenia (Child-Pugh class A/B/C: 34/34/34) were enrolled. Platelet counts, factors (F) II, V, VII, and VIII, antithrombin, protein C (PC), FVIII-to-PC ratio as an index of procoagulant imbalance, von Willebrand factor antigen (vWF-Ag), and model for end-stage liver disease (MELD) were evaluated. Two multivariate analyses were performed: one excluding (model 1) and one including MELD (model 2).



Higher vWF-Ag levels and FVIII-to-PC ratios were the most prominent hemostatic disorders in patients with cirrhosis. Increased levels of vWF-Ag and FVIII, and higher FVIII-to-PC ratios independently predicted the presence of ascites and varices at baseline. Independent predictors of ascites and VB during follow-up were vWF-Ag (model 1/2: p=0.001/p=0.009 and p=0.008/p=0.01, respectively) and FVIII-to-PC ratio (model 1/2: p=0.003/p=0.02 and p=0.01/p=0.03, respectively). vWF-Ag (model 1/2: p=0.007/p=0.002), FVIII-to-PC ratio (model 1/2: p=0.001/p=0.01), and MELD (p=0.02) independently predicted mortality. Patient groups with significantly higher probability of new-onset ascites, VB, and mortality were identified by certain cut-offs of vWF-Ag (213%, 466%, and 321%, respectively) and FVIII-to-PC ratio (1.99, 3.29, and 2.36, respectively). vWF-Ag and FVIII-to-PC ratio equaled MELD in mortality prediction.



Advanced cirrhosis is characterized by increased thrombotic potential. vWF-Ag and FVIII-to-PC ratio independently predict new-onset ascites, VB, and mortality. Targeting hypercoagulability could improve the outcome of patients with cirrhosis.



Higher von Willebrand factor antigen (vWF-Ag) levels and factor VIII-to-protein C (FVIII-to-PC) ratio are the prominent hemostatic disorders in patients with cirrhosis. vWF-Ag and FVIII-to-PC ratio independently predict new-onset ascites, variceal bleeding, and mortality in these patients.
1st Division of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece. Electronic address: gkalambo@cc.uoi.gr.
Georgios N
GN
Kalambokis
Hematology Laboratory Unit of Molecular Biology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Aikaterini
A
Oikonomou
1st Division of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Leonidas
L
Christou
Hematology Laboratory Unit of Molecular Biology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Nikolaos I
NI
Kolaitis
1st Division of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece; Division of Gastroenterology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Epameinondas V
EV
Tsianos
Division of Gastroenterology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Dimitrios
D
Christodoulou
Division of Gastroenterology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Gerasimos
G
Baltayiannis
D004932:Esophageal and Gastric Varices; D005169:Factor VIII; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D008103:Liver Cirrhosis; D013921:Thrombocytopenia; D014841:von Willebrand Factor
D014841:von Willebrand Factor; D005169:Factor VIII
Cirrhosis; Decompensation; Mortality; Procoagulant imbalance; von Willebrand factor antigen