von Willebrand factor in hospitalized patients with acute decompensation of cirrhosis is increased but not associated with development of ACLF

We read with interest the original article by Pomej et al, which was recently published in Digestive and Liver Disease [ [1] Pomej K Scheiner B Balcar L Nussbaumer RJ Weinzierl J Paternostro R et al. Clinical significance of substantially elevated von Willebrand factor antigen levels in patients with advanced chronic liver disease. Dig Liver Dis. 2022; 54: 1376-1384https://doi.org/10.1016/j.dld.2022.06.010 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. In a large, retrospective cohort of clinically stable patients with cirrhosis, these Authors demonstrated that a “substantially elevated” level of von Willebrand factor antigen (i.e.: >420%) was predictive of hepatic decompensation and liver-related mortality independently of age, etiology of liver disease, Child-Pugh stage, severity of portal hypertension, serum creatine, and C-reactive protein [ [1] Pomej K Scheiner B Balcar L Nussbaumer RJ Weinzierl J Paternostro R et al. Clinical significance of substantially elevated von Willebrand factor antigen levels in patients with advanced chronic liver disease. Dig Liver Dis. 2022; 54: 1376-1384https://doi.org/10.1016/j.dld.2022.06.010 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. Clinical significance of substantially elevated von Willebrand factor antigen levels in patients with advanced chronic liver diseaseDigestive and Liver DiseaseVol. 54Issue 10PreviewVon Willebrand factor antigen (VWF) is a non-invasive marker for clinically significant portal hypertension (HVPG≥10 mmHg) and confers HVPG-independent prognostic information. While quantification of increased VWF-levels is not relevant in the context of von Willebrand disease, highly elevated VWF may be of clinical significance in ACLD. Thus, we have modified our analytical approach to quantify very high VWF-levels (i.e.,>420%) and investigated their prognostic value. Full-Text PDF Open AccessReply to comment: Von Willebrand factor measurement during acute decompensationDigestive and Liver DiseaseVol. 55Issue 1PreviewWe would like to thank Dr. Zanetto and colleagues for their interest in our work and for sharing their valuable findings in regard to plasma von Willebrand factor antigen (VWF:Ag) levels in patients with acute decompensation (AD) and their lack of association with acute-on-chronic liver failure (ACLF) development and death [1]. Full-Text PDF