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 - PubMed (original) (raw)

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

Stephanie Hametner et al. PLoS One. 2016.

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.

Aim: 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.

Conclusion: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1

Fig 1. Correlation of Von Willebrand factor antigen (vWF-Ag) and CSPH.

Mean values of vWF-Ag shown in boxplots for a cohort of patients with and without CSPH each.

Fig 2

Fig 2. Correlation of aspartate aminotransferase to platelet ratio index (APRI) and CSPH.

Mean values of APRI shown in boxplots for a cohort of patients with and without CSPH each.

Fig 3

Fig 3. Correlation of VITRO (VWF-Ag/platelets) score and CSPH.

Mean values of VITRO score shown in boxplots for a cohort of patients with and without CSPH each.

Fig 4

Fig 4. Correlation of enhanced liver fibrosis test (ELF) test and CSPH.

Mean values of ELF test shown in boxplots for a cohort of patients with and without CSPH each.

Fig 5

Fig 5. Correlation of transient elastography (TE; kPa) and CSPH.

Mean values of TE shown in boxplots for a cohort of patients with and without CSPH each.

Fig 6

Fig 6. ROC analysis shows the ability of Von Willebrand factor antigen (vWF-Ag) predicting clinically significant portal hypertension (CSPH).

ROC analysis showing the diagnostic ability of vWF-Ag detecting CSPH with an AUC of 0.79.

Fig 7

Fig 7. ROC analysis shows the ability of aspartate aminotransferase to platelet ratio index (APRI) predicting clinically significant portal hypertension (CSPH).

ROC analysis showing the diagnostic ability of APRI detecting CSPH with an AUC of 0.62.

Fig 8

Fig 8. ROC analysis shows the ability of VITRO (VWF-Ag/platelets) score predicting clinically significant portal hypertension (CSPH).

ROC analysis showing the diagnostic ability of VITRO score detecting CSPH with an AUC of 0.86.

Fig 9

Fig 9. ROC analysis shows the ability of enhanced liver fibrosis test (ELF) predicting clinically significant portal hypertension (CSPH).

ROC analysis showing the diagnostic ability of ELF test detecting CSPH with an AUC of 0.68.

Fig 10

Fig 10. ROC analysis shows the ability of transient elastography (TE) predicting clinically significant portal hypertension (CSPH).

ROC analysis showing the diagnostic ability of TE detecting CSPH with an AUC of 0.92.

Fig 11

Fig 11. ROC analysis shows the ability of the combination of TE and VITRO score predicting clinically significant portal hypertension (CSPH).

ROC analysis showing the diagnostic ability of TE in combination with VITRO score detecting CSPH with an AUC of 0.96.

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