Value of vWF-related indicators in the diagnosis of liver cirrhosis progression in patients with hepatitis B

doi:10.16150/j.1671-2870.2024.06.003

Abstract

Abstract:

Objective To evaluate the correlation between von Willebrand factor (vWF) and its related indicators and the progression of liver cirrhosis in patients with hepatitis B and explore the diagnostic value of vWF-related indicators in assisting the diagnosis of decompensated liver cirrhosis in patients with hepatitis B.Methods A total of 91 hepatitis B patients hospitalized in the Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from December 2020 to March 2021, were included. According to the diagnostic criteria for liver cirrhosis, the patients were divided into three groups: chronic hepatitis B group (31 cases), compensated hepatitis B cirrhosis group (18 cases), and decompensated hepatitis B cirrhosis group (42 cases). The vWF antigen level (vWF: Ag), vWF collagen binding activity (vWF: CB), and vWF propeptide (vWFpp) were measured by ELISA. The vWF: CB/ vWF: Ag ratio was used to reflect the distribution of vWF multimers of different molecular weights. The vWFpp/vWF: Ag ratio was used to reflect the clearance rate of vWF in vivo. The ratio of vWF: Ag/platelet count was used to calculate the VITRO score. The SPSS 26.0 software was used for intergroup comparison, correlation analysis, and to assess the diagnostic performance of each indicator for decompensated hepatitis B cirrhosis.Results The levels of plasma vWF: Ag, vWF: CB, vWFpp, and vWFpp/vWF: Ag were significantly higher in the decompensated hepatitis B cirrhosis group than in the compensated group. However, there were no significant differences in the ratio of vWF: CB/vWF: Ag and VITRO scores between the two groups. The vWF: Ag, vWF: CB and vWFpp showed moderate positive correlations with Child-Pugh score in patients with chronic hepatitis B, with r values of 0.604, 0.593, and 0.711, respectively (P<0.05). When the cut-off value of vWFpp was set over 305.5%, its diagnostic efficacy for decompensated hepatitis B cirrhosis was highest, with a sensitivity of 78.6%, specificity of 93.9%, positive predictive value of 91.7%, negative predictive value of 83.6%, diagnostic accuracy of 86.8%, and area under the curve of 0.899.Conclusion The levels of vWF: Ag and vWFpp in plasma are well correlated with Child-Pugh liver function classification in patients with chronic hepatitis B, and can be used to assist in the diagnosis of decompensated liver cirrhosis of chronic hepatitis B, guiding patient treatment.

Key words: Von Willebrand factor, Hepatitis B, Child-Pugh liver function score, Decompensated liver cirrhosis

CLC Number:

R575.2
R446

YANG Mingkang, LIU Yu, XU Guanqun, WANG Jianbiao, WANG Xuefeng, LIANG Qian. Value of vWF-related indicators in the diagnosis of liver cirrhosis progression in patients with hepatitis B[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(06): 574-579.

Figures/Tables 5

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References 21

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Index	Chronic Hepatitis B (n=31)	Compensated cirrhosis (n=18)	Decompensated cirrhosis (n=42)	Reference range	Statistical value	P
Age (year，M(QR))	47(38-63)	52(46-57)	56(45-62)	/	H=2.079	0.354
Sex (male/female)	23/8	17/1	36/6	/	X²=83.583	0.209
INR	1.10(1.06-1.26)	1.34(1.17-1.72)	1.55(1.29-1.97)	/	H=31.238	<0.001
PLT [×10⁹/L, M (QR)]	128(80-165)	68(40-106)	74(55-125)	125-350	H=15.279	<0.001
ALT [U/L, M (QR)]	47(25-88)	57(28-113)	44(19-126)	9-50	H=0.885	0.642
AST [U/L, M (QR)]	43(29-72)	75(34-179)	74(34-210)	15-40	H=6.043	0.049
ALP [U/L, M (QR)]	104(90-141)	124(94-161)	131(91-166)	45-125	H=1.420	0.492
γ-GT [U/L, M (QR)]	78(38-153)	80(33-103)	55(29-107)	10-60	H=1.738	0.419
TP [U/L, M (QR)]	64(57-69)	62(58-69)	58(55-64)	60-83	H=5.165	0.076
Alb [g/L, M (QR)]	35(32-42)	34(30-37)	30(27-33)	35-55	H=15.439	<0.001
TBil [μmol/L, M (QR)]	24.0(14.0-78.0)	51.7(27.3-225.7)	86.6(37.0-337.8)	4.7-24.0	H=15.038	<0.001
vWF:Ag [%, M (QR)]	147.6(99.7-211.7)	212.4(154.7-229.1)	275.9(194.8-360.0)	50.0-150.0	H=29.650	<0.001
vWF:CB [%, M (QR)]	135.2(94.4-190.2)	182.0(163.1-221.2)	251.8(203.0-290.7)	50.0-150.0	H=32.569	<0.001
vWFpp [%, M (QR)]	131.7(181.3-226.0)	230.9(161.2-286.7)	451.1(319.2-614.0)	50.0-150.0	H=45.388	<0.001
vWF:CB/vWF:Ag	0.90(0.84-0.99)	0.96(0.83-1.07)	0.90(0.83-0.94)	0.80-1.20	H=1.997	0.369
vWFpp/vWF:Ag	1.07(0.89-1.50)	1.07(0.98-1.35)	1.57(1.27-1.93)	0.80-1.20	H=19.832	<0.001
VITRO	1.18(0.66-1.65)	3.13(1.93-4.60)	3.33(2.18-5.56)	/	H=30.612	<0.001

Index	Correlation analysis
Index	r	P
vWF:Ag	0.604	<0.001
vWF:CB	0.593	<0.001
vWFpp	0.711	<0.001
vWF:CB/vWF:Ag	-0.235	0.025
vWFpp/vWF:Ag	0.411	<0.001
VITRO	0.423	<0.001

Index	Cut-off value	Sensitivity(%)	Specificity(%)	PPV(%)	NPV(%)	Accuracy（%）	AUC	P
vWF:Ag	234.4	66.7	85.7	80.0	75.0	76.9	0.809	<0.001
vWF:CB	204.5	76.2	81.6	78.0	80.0	79.1	0.821	<0.001
vWFpp	305.5	78.6	93.9	91.7	83.6	86.8	0.899	<0.001
vWFpp/vWF:Ag	1.34	73.8	73.5	70.5	76.6	73.6	0.772	<0.001
VITRO	2.52	73.8	71.4	68.9	76.1	72.5	0.753	<0.001