Prognostic value of the ADAMTS13-vWF axis in disseminated intravascular coagulation: Platelet count/vWF:Ag ratio as a strong prognostic marker

Abstract

© 2021 John Wiley & Sons Ltd.Introduction: ADAMTS13 deficiency increases the circulating level of von Willebrand factor (vWF). Low ADAMTS13 and high vWF can provide a milieu for microthrombosis, including disseminated intravascular coagulation (DIC). This study investigated the prognostic values of ADAMTS13–vWF axis markers and their correlation with DIC severity. Methods: ADAMTS13–vWF axis markers (vWF antigen (vWF:Ag), vWF ristocetin cofactor (vWF:Rco), ADAMTS13 activity, and anti-ADAMTS13 antibody) were measured in patients (n = 152) suspected of having DIC along with the well-known DIC markers including antithrombin and protein C. Result: The vWF:Ag level was significantly increased, and ADAMTS13 activity was significantly decreased in overt DIC. The vWF:Ag level (hazard ratio 7.365, p =.009), ADAMTS13 activity/vWF:Ag ratio (hazard ratio 3.777, p =.037), ADAMTS13 activity/vWF:Rco ratio (hazard ratio 3.027, p =.028), and platelet count/vWF:Ag ratio (hazard ratio 8.538, p <.001) were significant prognostic markers in Cox regression analysis and correlated well with DIC score and antithrombin and protein C levels. Conclusion: The platelet count/vWF:Ag was the strongest prognostic marker among ADAMTS13–vWF axis markers. The measurement of vWF:Ag may improve prognostic insights of DIC in clinical practice.