Association of von Willebrand factor Ag-to-ADAMTS13 ratio with early sepsis-related mortality

Abstract

IntroductionSepsis is a highly complex syndrome with highly heterogeneous clinical manifestations, which makes it difficult to detect and treat. Von Willebrand factor (vWF) functions differently depending on its multimeric size and adhesive properties, which are regulated by ADAMTS 13. Thus, a decrease in ADAMTS 13 activity results in the persistence of ultralarge vWF and the formation of microvascular thrombi, ischaemia, and organ failure. The aim of the study was to identify the role of von Willebrand factor antigen-to-ADAMTS 13 ratio in predicting early sepsis-related mortality.Material and methodsThis is a cohort of 70 sequentially selected adults with sepsis. The patients were classified into two groups: A (survivors) and B (non-survivors) based upon their survival within 7 days of hospital admission.ResultsVWF Ag, ADAMTS13, and vWF/ADAMTS13 ratio were significant predictors of early hospital mortality. For vWF Ag at a cut-off level of ≥ 3560 ng/l, sensitivity was 76% and specificity was 88.9%. For ADAMTS at a cut-off level of ≤ 210 ng/l, sensitivity was 84% and specificity was reported as 68.9%. For vWF/ADAMTS ratio at a cut off level of ≥ 17, sensitivity was 80% and specificity was 84.4%. There was a statistically highly significant positive correlation between non-survival and levels of vWF and vWF/ADAMTS 13 ratio, and there was a statistically highly significant negative correlation between non-survival and ADAMTS 13 level.ConclusionsHigh vWF/Ag and vWF/Ag/ADAMTS13 ratios on day 1 of admission are associated with increased early (7 days) sepsis-related mortality.