The von Willebrand Factor antigen to platelet ratio (VITRO) score predicts hepatic decompensation and mortality in cirrhosis

Rémy Schwarzer, Thomas Reiberger, Mattias Mandorfer, Danijel Kivaranovic, Silvia Hametner, Stephanie Hametner, Rafael Paternostro, Bernhard Scheiner, Jenifer Schneeweiss-Friedl, Michael Trauner, Rainer Schoefl, Andreas Maieron

Research output: Journal article (peer-reviewed)Journal article

16 Citations (Scopus)


BACKGROUND: The ratio of von Willebrand Factor to platelets (VITRO) reflects the severity of fibrosis and portal hypertension and might thus hold prognostic value.

METHODS: Patients with compensated cirrhosis were recruited. VITRO, Child-Pugh score (CPS) and MELD were determined at study entry. Hepatic decompensation was defined as variceal bleeding, ascites or hepatic encephalopathy. Liver transplantation and death were recorded.

RESULTS: One hundred and ninety-four patients with compensated cirrhosis (CPS-A 89%, B 11%; 56% male; median age 56 years; 50% with varices) were included. During a median follow-up of 45 months (IQR 29-61), decompensation occurred in 35 (18%) patients and 14 (7%) patients deceased. The risk of hepatic decompensation was significantly increased in the n = 88 (45%) patients with a VITRO ≥ 2.5 (p < 0.001). Patients with a VITRO ≥ 2.5 had a higher probability of decompensation at 1-year 9% (95% CI 3-16) vs. 0% (95% CI 0-0) and at 2-years 18% (95% CI 10-27%), vs. 4% (95% CI 0-8%) as compared to patients with VITRO < 2.5. Patients with VITRO ≥ 2.5, the estimated 1-year/2-year survival rates were at 98% (95% CI 95-100%) and 94% (95% CI 88-99%) as compared to 100% (95% CI 100-100%) both in the patients with a VITRO < 2.5 (p < 0.001). After adjusting for age, albumin and MELD, VITRO ≥ 2.5 remained as significant predictor of transplant-free mortality (HR 1.38, CI 1.09-1.76; p = 0.007). Patients with compensated cirrhosis and VITRO > 2.1 after hepatitis C eradication remained at significantly increased risk for decompensation (p = 0.033).

CONCLUSIONS: VITRO is a valuable prognostic tool for estimating the risk of decompensation and mortality in patients with compensated cirrhosis-including the setting after hepatitis C eradication.

Original languageEnglish
Pages (from-to)533-542
Number of pages10
JournalJournal of Gastroenterology
Issue number5
Publication statusPublished - 01 May 2020


  • Ascites/epidemiology
  • Blood Platelets/metabolism
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage/epidemiology
  • Hepatic Encephalopathy/epidemiology
  • Humans
  • Liver Cirrhosis/mortality
  • Liver Transplantation
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • von Willebrand Factor/metabolism


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