Evidence map›Paper›PMID 38046943›Full record

ArticleJHEP reports : innovation in hepatology2023

Transient elastography and von Willebrand factor as predictors of portal hypertension and decompensation in children.

Akshat Goel, Robert Hegarty, Shweta Dixit, Bethany Tucker, Abdel Douiri, Eirini Kyrana, Vandana Jain, Anil Dhawan, Tassos Grammatikopoulos

Abstract read
In one paragraph

Article in JHEP reports : innovation in hepatology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Article
  4. Article
  5. Article
  6. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Akshat GoelPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Robert HegartyPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Shweta DixitPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Bethany TuckerPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Abdel DouiriFaculty of Life Sciences and Medicine, King's College, London, UK.
Eirini KyranaPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Vandana JainPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Anil DhawanPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.
Tassos GrammatikopoulosPaediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background & Aims: Von Willebrand factor antigen (vWFAg), a protein measured to test the level of vWF released from the vascular endothelium has gained much attention as a marker for portal hypertension (PHT) severity. The objectives of this study were to investigate the use of vWFAg as a biomarker along with liver and spleen stiffness measurements by transient elastography as potential predictors of clinically significant varices (CSV), variceal bleeding (VB) and decompensation in children with PHT. Methods: This observational prospective cohort study included 117 children (median age 10 [IQR 6-14] years) who underwent oesophagogastroduodenoscopy between January'2012 to November'2021 and a validation group of 33 children who underwent the same procedure between December'2021 to March'2023. Measurements of vWFAg and glycoprotein Ib binding activity of VWF (GPIbR) were available in 97 patients in the study group and in all patients in the validation group. Conclusions: This study suggests the predictive value of vWF for CSV and VB increases when combined with spleen stiffness, with AUROCs of 0.88 and 0.82, respectively. Hence, a combination of biomarkers could assist clinicians in diagnosing CSV, preventing unnecessary invasive procedures. Impacts and implications: Surveillance endoscopies in children with portal hypertension (PHT) have their own risks and non-invasive markers, such as von Willebrand factor antigen, glycoprotein Ib binding activity of VWF (GPIbR), and transient elastography could be used to predict clinically significant varices, variceal bleeding and disease compensation in children with PHT. Such non-invasive markers for PHT and varices are lacking in the paediatric population. The results show that von Willebrand factor and GPIbR along with transient elastography can be used to formulate a scoring system which can be used as a clinical tool by paediatric hepatologists to monitor the progression of PHT and risk of bleeding, and hence to stratify the performance of invasive endoscopic procedures under general anaesthesia. However, there is a need to validate the scoring system in children with portal vein thrombosis and for hepatic decompensation in a multi-centre registry in the future.

Indexed as

BiomarkersClinically significant varicesLiver StiffnessSpleen StiffnessVariceal Bleeding

Identifiers

PMID38046943
PMCPMC10692718

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.