Utility of combined use of elastography and von Willebrand factor antigen/thrombocyte ratio in prediction of gastroduodenal mucosal portal hypertension related vascular lesions

Gamal Ahmed Abdel Khalik Badra; Hanaa Badran; Olfat Mohamed Hendy; Lashin Saad Ali; Mostafa El Helbawy

doi:10.53730/ijhs.v7nS1.14620

Authors

Gamal Ahmed Abdel Khalik Badra Menoufia University, Egypt
Hanaa Badran Menoufia University, Egypt
Olfat Mohamed Hendy Menoufia University, Egypt
Lashin Saad Ali Al-Ahliyya Amman University, Amman, Jordan | Menoufia University, Egypt
Mostafa El Helbawy Menoufia University, Egypt

Keywords:

portal hypertension, Paveno criteria, platelets, transient elastography, vWF Ag, VITRO score

Abstract

Background: Liver cirrhosis is the most important cause of portal hypertension, esophageal varices (EVs) represent its major complication as they may rupture and bleed with increased mortality rate. vWF-Ag is an established and valuable marker for determining the grade of fibrosis and cirrhosis and for mortality in patients with cirrhosis. Aim of our work is to search for the utility of combined use of elastography and Von Willebrand Factor Antigen/Thrombocyte Ratio in prediction of gastroduodenal portal hypertension related vascular lesions and identify suitable cutoff values for predicting these lesions. Patients and methods: 80 cirrhotic patients, were divided into 2 main groups, Group I included 20 patients with no evidence of portal hypertension related vascular lesions as verified by endoscopic examination (disease control group), group II, included patients with vascular lesions and was divided into 3 subgroups groups, group IIa included 20 patients with esophageal varices or gastro-esophageal varices, group IIb included 20 patients with isolated gastric varices, group IIc included 20 patients with portal hypertension related lesions other than esophageal and gastric varices.

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References

Shung DL, Garcia-Tsao G (2017) Liver Capsule: Portal hypertension and varices: pathogenesis, stages, and management. Hepatology 65:1038.

Treiber G, Csepregi A, Malfertheiner P (2005) The pathophysiology of portal hypertension. Digest Dis 23:6–10.

Iwakiri Y (2014) Pathophysiology of portal hypertension. Clin Liver Dis 18: 281–291.

Gulamhusein AF, Kamath PS (2017) The epidemiology and pathogenesis of gastrointestinal varices. Tech Gastrointest Endo 19:62–68.

de Franchis R, Dell’Era A (2014) Invasive and noninvasive methods to diagnose portal hypertension and esophageal varices. Clin Liver Dis 18:293– 302.

Tsochatzis EA, Bosch J, Burroughs AK (2014) Liver cirrhosis. Lancet 383:1749– 1761.

de Franchis R (2015) Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 63:743–752.

Shin SU, Lee J-M, Yu MH et al (2014) Prediction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique. Radiology July 272(1):143–153.

European Association for Study of Liver; Associacion Latinoameri-canapara el Estudio del Higado EASL-ALEH clinical practice guidelines (2015) non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 63:237–264.

Matei V, Rodriguez-Vilarrupla A, Deulofeu R, Colomer D, Fernandez M, Bosch J, et al. The eNOS cofactor tetrahydrobiopterin improves endothelial dysfunction in livers of rats with CCl4 cirrhosis. Hepatology. 2006; 44(1):44–52. Epub 2006/06/27. doi: 10.1002/hep.21228 PMID: 16799985.

Qamar AA, Grace ND, Groszmann RJ, Garcia-Tsao G, Bosch J, Burroughs AK, et al. Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2009; 7(6):689–95. Epub 2009/03/14. doi: 10.1016/j.cgh.2009.02.021 PMID: 19281860; PubMed Central PMCID: PMCPMC4545534.

Hollestelle MJ, Geertzen HGM, Straatsburg IH, et al. Factor VIII expression in liver disease. Thromb Haemost 2004;91:267–75.

Lisman T, Bongers TN, Adelmeijer J, Janssen HL, de Maat MP, de Groot PG and Leebeek FW.Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity. HEPATOLOGY. 2006; 44:53-61.

Ferlitsch M, Reiberger T, Hoke M, Salzl P,Schwengerer B, Ulbrich G, Payer BA, Trauner M, Peck-Radosavljevic M, and Ferlitsch A. von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis.HEPATOLOGY. 2012; 56 (4): 1439-1447.

Naglaa El-Toukhy and Hisham Issa. Predictive and Prognostic Value of Von Willebrand Factor in Patients with Cirrhosis and Esophageal Varices. Afro-Egypt J Infect Endem Dis 2019; 9(1):67-73.

Maieron A, Salz P, Trauner M, Hametner S. Von Willebrand Factor as a new marker for non-invasive assessment of liver fibrosis and cirrhosis in patients with chronic hepatitis C. Aliment PharmacolTher.2014; 39: 331–338.

de Franchis R, Faculty BVI. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension.J Hepatol. 2015;63:743–52.

Schwarzer R, Reiberger T, Mandorfer M, et al. The von Willebrand Factor antigen to platelet ratio (VITRO) score predicts hepatic decompensation and mortality in cirrhosis. J Gastroenterol.2019;5:5.