Mandorfer M, et al. - Elevated plasma von Willebrand factor antigen (vWF) has been shown to indicate the presence of clinically significant portal hypertension, and thus, predicts the development of clinical events in patients with cirrhosis. In this current study, the effect of bacterial translocation and inflammation on vWF, as well as the link between vWF and procoagulant imbalance, was investigated. Also, whether vWF predicts complications of cirrhosis, independent of the severity of portal hypertension, was also inquired. vWF was identified as a marker of portal hypertension. Moreover, its independent link with bacterial translocation, inflammation, and procoagulant imbalance was apparent, which might explain its hepatic venous pressure gradient (HVPG)-independent association with most clinical events. Patients with a poor 5-year survival and patients with a favourable prognosis were differentiated efficiently by prognostic groups based on vWF/C-reactive protein.

• This study included a total of 225 patients with hepatic venous pressure gradient (HVPG) ≥ 10 mm Hg without active bacterial infections or hepatocellular carcinoma.

• Findings demonstrated correlation of vWF with markers of bacterial translocation (lipopolysaccharide-binding protein [LBP; ρ = 0.201; P=0.021]), inflammation (interleukin 6 [IL-6; ρ = 0.426; P < 0.001] and C-reactive protein [CRP; ρ = 0.249; P < 0.001]), and procoagulant imbalance (factor VIII/protein C ratio; ρ = 0.507; P < 0.001).
• Essentially, vWF and these parameters were found to be associated, independently of HVPG.
• Moreover, researchers identified that vWF (per 10%) independently predicted variceal bleeding (hazard ratio [HR]: 1.08 [95% confidence interval (95% CI): 1.01-1.16]; P=0.023), requirement of paracentesis (HR: 1.05 [95% CI: 1.01-1.1]; P=0.023) and bacterial infections (HR: 1.04 [95% CI: 1-1.09]; P=0.04) including spontaneous bacterial peritonitis (HR: 1.09 [95% CI: 0.999-1.18]; P=0.053) on a trend-wise level.
• In addition, after backward elimination, vWF (HR: 1.05 [95% CI: 1.02-1.08]; P=0.003) and CRP (per 10 mg/L; HR: 1.53 [95% CI: 1.14-2.05]; P=0.005) remained in the final model for transplant-free mortality.
• By competing risk analysis, the independent prognostic value of vWF/CRP groups for mortality was corroborated.