Thesis (M.Sc.)-Cairo University, 2022.

Bibliography: pages 83-112.

Variceal bleeding is a gastrointestinal emergency that is one of the major causes of death in patients with cirrhosis. Von Willebrand factor antigen (vWF-Ag), a protein released by endothelial cells (ECs), reflects EC activation. Levels of vWF had been discovered to be higher in people with liver cirrhosis; there is a scarcity of information about its role in prediction of portal hypertensive bleeding. vWF-Ag was combined with platelet count to develop a novel prediction score, the von Willebrand factor antigen/thrombocyte ratio
(the VITRO score)
Aim of the Work: To assess the relationship between the von Willebrand factor and the VITRO score with variceal bleeding in cirrhotic patients.
Patients and Methods: 42 cirrhotic patients and 17 healthy controls were included in the study. The patients were categorized into two groups: 21 cirrhotic patients presenting with variceal bleeding and 21 cirrhotic patients without history of variceal bleeding. All patients underwent lab assessment [mainly vWf-Ag] and upper endoscopy vWf-Ag and the VITRO score were compared between cirrhotic cases with variceal bleeding and without it and with 17 normal subjects.
Results: The patients with variceal bleeding had significantly higher level of vWF (12ng/ml ranging from 7.1–48.5ng/ml), compared to patients without bleeding (9.2ng/ml) and normal controls (9.6ng/ml). Patients with variceal bleeding had higher VITRO score (0.174 ranging from 0.045 to 0.866), compared to patients without bleeding (0.058ng/ml) and normal controls (0.037ng/ml), the difference was statistically significant.
Conclusion: We suggest that the vWF and the VITRO score can be used as noninvasive biomarkers for the prediction of variceal bleeding in patients with liver cirrhosis with high sensitivity and specificity.

يعتبر نزيف دوالي المريء من المشكلات الصحية الطارئة والتي تعد واحدة من اهم أسباب الوفاة لمرضى تليف الكبد. حيث يعتمد مصير هؤلاء المرضى على القدرة على الارقاء وتجنب المضاعفات سواء المتعلقة بالنزيف او المرتبطة بأمراض الكبد المزمنة. حيث ترتبط كل نوبة من نزيف الدوالي بمعدل وفيات يصل الى 20 بالمائة تهدف هذه الدراسة الى تحديد تأثير عامل von willebrand و vitro score في التنبؤ بنزيف الدوالي لدى مرضى تليف الكبد .
فى الختام نقترح استخدام عامل فون ويلبراند ومقياس فيترو كمؤشرات حيوية غير جراحية لارتفاع خطر نزيف الدوالي في المرضى الذين يعانون من تليف الكبد

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