VWF/ADAMTS13 Ratio as a Potential Predictive Biomarker for Acute Kidney Injury Onset in Cirrhosis.

ABSTRACT

AIM: We investigated the von Willebrand factor to ADAMTS13 ratio (von Willebrand factor [VWF]Ag/ADAMTS13AC) as a potential biomarker for the outcomes of acute kidney injury (AKI) in liver cirrhosis (LC). METHODS: This retrospective cross-sectional study included patients with LC who developed AKI (AKI group n = 91) and patients with LC who did not develop AKI [non-AKI (NAKI) group, n = 91] as a control group. Plasma levels of the von Willebrand factor antigen (Ag) and ADAMTS13 activity (AC) were measured in patients with AKI or NAKI. Moreover, risk factors for onset of AKI, AKI-associated 90-day mortality, and poor AKI treatment response were identified. RESULTS: The AKI group had a significantly higher VWFAg/ADAMTS13AC than the NAKI group. Values of VWFAg/ADAMTS13AC ≥ 5.7 were identified as risk factors for AKI onset in patients with LC (odds ratio [OR] 2.56; 95% CI 1.26-4.99; p < 0.001). Among patients with AKI, values of VWFAg/ADAMTS13AC ≥ 9.0 were identified as risk factors for 90-day mortality (OR 6.83; 95% CI 2.32-20.10; p < 0.001). Cumulative survival was significantly lower in those with high (≥ 9.0) than in those with low (< 9.0) VWFAg/ADAMTS13AC. Furthermore, values of VWFAg/ADAMTS13AC ≥ 7.4 were identified as risk factors for poor treatment response (OR 4.2; 95% CI 1.39-12.70; p < 0.001). The treatment response rates were significantly higher in those with low (< 7.4) VWFAg/ADAMTS13AC than in those with high (≥ 7.4) VWFAg/ADAMTS13AC. CONCLUSION: VWFAg/ADAMTS13AC potentially predicts the onset, prognosis, and treatment response of AKI in patients with LC.