Von Willebrand factor and esophageal varices 
in children with chronic liver diseases

Mohamed Abdel-Salam El-Guindi; Nermin Mohammed Adawy; Iman Shaban Osheba; Wafaa Masoud Khalifa; Hosam Eldin Mohammed Basiouny

doi:10.5114/ceh.2021.109672

eISSN: 2449-8238
ISSN: 2392-1099

Clinical and Experimental Hepatology

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abstract:

Original paper

Von Willebrand factor and esophageal varices in children with chronic liver diseases

Mohamed Abdel-Salam El-Guindi

¹

,

Nermin Mohammed Adawy

¹

,

Iman Shaban Osheba

²

,

Wafaa Masoud Khalifa

³

,

Hosam Eldin Mohammed Basiouny

¹

Department of Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University, Shebin El-koom, Menoufia, Egypt
Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin El-koom, Menoufia, Egypt
Department of Pediatrics, Mahalet Marhom hospital, Algharbeia, Ministry of Health and Population, Egypt

Clin Exp HEPATOL 2021; 7, 4: 429-436

DOI: https://doi.org/10.5114/ceh.2021.109672

Online publish date: 2021/12/23

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Introduction
To evaluate the role of plasma level of von Willebrand factor antigen (vWF-Ag) as a possible predictor for the presence of esophageal varices (EVs) in children with chronic liver diseases (CLDs).

Material and methods
All patients underwent upper esophagogastroduodenoscopy (EGD) and were categorized as group I (had EVs) and group II (had no EVs). The following patient data were determined: Child-Pugh score (CPS), plasma vWF-Ag, vWF-Ag/thrombocyte ratio (VITRO) score, aspartate transaminase (AST) to platelet ratio index (APRI) score, AST/alanine transaminase (ALT), platelet count/spleen diameter, grading of EVs (small, medium and large) and categorizing the stage of liver fibrosis.

Results
The analysis included 50 patients with CLD; 30 (60%) were female. The commonest etiological diagnoses were autoimmune hepatitis (AIH) (20%) and extra-hepatic biliary atresia (EHBA) (12%). 26% of cases were categorized as undiagnosed CLD. The CPS showed CPS-A 34%, CPS-B 44% and CPS-C 22%. The vWF-Ag was found at a high level of 243.52 ±195.97, with a highly statistically significant difference in discriminating the EVs with 74% accuracy at a cut-off value of 108.99 IU/ml, p < 0.0001. Also, ROC analysis was performed for discriminating large esophageal varices with 84% accuracy at a cut-off value of 475.85 mg%. The VITRO score at a cut-off value of 1.72 could detect EVs with 70% sensitivity, 86.7% specificity, and 80% accuracy.

Conclusions
High vWF-Ag is a valuable prognostic tool for estimating the presence of EVs, and higher vWF-Ag is associated with increased grade of EVs.

keywords:

Von Willebrand factor and esophageal varices in children with chronic liver diseases

Mohamed Abdel-Salam El-Guindi 1 , Nermin Mohammed Adawy 1 , Iman Shaban Osheba 2 , Wafaa Masoud Khalifa 3 , Hosam Eldin Mohammed Basiouny 1

chronic liver diseases, von Willebrand factors, esophageal varices

Mohamed Abdel-Salam El-Guindi

¹

,

Nermin Mohammed Adawy

¹

,

Iman Shaban Osheba

²

,

Wafaa Masoud Khalifa

³

,

Hosam Eldin Mohammed Basiouny

¹