ADAMTS13 and von Willebrand Factor Levels in Patients with Chronic Hepatitis C: Relations to Hemostatic Imbalance and Bacterial Infection

Abstract

Cirrhosis is an increasing cause of morbidity and mortality, being the 14th most common cause of death worldwide. Normal plasma VWF levels and normal platelet number and function are all irreplaceable factors for a physiologic primary hemostasis. Patients with liver cirrhosis have a more complex coagulation state than previously believed. They display a global hemostatic alteration, involving both pro- and anticoagulant factors. Liver cirrhosis is in close association with bacterial translocation as a result of alteration of intestinal barrier and furthermore endotoxemia. Several mechanisms contribute to systemic inflammation in cirrhosis. Infection increases mortality in cirrhosis four times and has a poor prognosis, with 30% of patients dying within a month of infection and another 30% within a year. SBP is one of the most frequent bacterial infections in patients with cirrhosis and ascites, occurring in 10% to 25% of these patients. ADAMTS13 is a metalloprotease of that is synthesized primarily in HSCs, and VWF is its only known substrate. ADAMTS13 is an indicator of liver function capacity. Inflammatory processes may directly modulate ADAMTS13 expression and activity. Decreased ADAMTS13 activity is