Elevated ADAMTS13 Activity is Associated with Poor Postoperative Outcome in Patients Undergoing Liver Resection

Abstract

Recently, von-Willebrand-Factor (vWF) has been shown to correlate with postoperative liver dysfunction (LD). Accordingly, "disintegrin-like metalloprotease with thrombospondin type1 motif" (ADAMTS13) is known to cleave vWF in less active fragments. Thus, we aimed to evaluate the diagnostic potential of ADAMTS13-activity (ADAMTS13-AC) to identify patients with postoperative LD after hepatectomy. Accordingly 37 patients undergoing hepatectomy for different neoplastic entities were included in this study. Plasma ADAMTS13-AC and vWF-Ag were measured 1 day prior to (preOP), 1 and 5 days (POD1/5) after hepatectomy. In accordance to the ISGLS-criteria LD was prospectively recorded. In this context, perioperative ADAMTS13-AC- and vWF-Ag/ADAMTS13-AC-ratio- levels revealed a significant increase after hepatectomy. Accordingly, elevated vWF-Ag/ADAMTS13-AC-ratio significantly predicted LD (preOP AUC: 0.75, p = 0.02; POD1 AUC: 0.80, p = 0.03). Patients who fulfilled our perioperative vWF-Ag/ADAMTS13-AC-ratio cut-off-levels (preOP: ≥116, POD1: ≥165) suffered from significantly higher incidences of LD (preOP: 70% vs. 30%, p = 0.01; POD1: 83% vs. 17%, p = 0.001). In conclusion, perioperative ADAMTS13-AC measurement may serve as a useful parameter to early detect high-risk patients developing postoperative LD prior to liver resection in patients suffering from hepatic malignancies. Indeed, further investigations have to be performed to consolidate its role as a predictive marker for LD.

Figure 1

Perioperative time course of ADAMTS13-AC, VWF-AG, TSP-1 as well as VWF-AG/ADAMTS13-AC ratio. Perioperative activity values and antigen levels were measured one day prior to (PreOP), one day after (POD1) as well as 5 days after (POD5) liver resection and are shown separately in accordance to ADAMTS13-AC (A), vWF-Ag (B), TSP-1 (C) as well as vWF-Ag/ADAMTS13-AC ratio (D). Boxplot illustrations are given without outliers and extreme values to improve the resolution of interquartile ranges. ^*P < 0.05, ^**P < 0.005.

Figure 2

Perioperative time course of ADAMTS13-AC, VWF-AG, TSP-1 as well as VWF-AG/ADAMTS13-AC ratio in accordance to postoperative complications. Perioperative activity values and antigen levels were measured one day prior to (PreOP), one day after (POD1) as well as 5 days after (POD5) liver resection. Accordingly, ADAMTS13-AC (A), vWF-Ag (B), TSP-1 (C) as well as vWF-Ag/ADAMTS13-AC ratio (D) levels were evaluated and are shown in accordance to the occurrence of postoperative liver dysfunction (LD). Boxplot illustrations are given without outliers and extreme values to improve the resolution of interquartile ranges. ^*P < 0.05, ^**P < 0.005.

Figure 3

Pre- as well as postoperative potential of ADAMTS13-AC to predict postoperative LD. Receiver operating characteristic (ROC) curve analysis for preoperative (PreOP, A) as well as postoperative day 1 (POD1, B) ADAMTS13-AC values to detect postoperative liver dysfunction (LD) are illustrated. ROC curve analysis includes the evaluation of its related area under the curve (AUC). Furthermore incidences of postoperative LD are shown in accordance to preOP (≥0.68 IU/ml, C) as well as POD1 (≥0.56 IU/ml, D) defined cut-off values of ADAMTS13-AC. ^*P < 0.05, ^**P < 0.005.

Figure 4

Perioperative potential of VWF-AG/ADAMTS13-AC ratio to predict poor postoperative performance. Receiver operating characteristic (ROC) curve analysis for preoperative (PreOP, A) as well as postoperative day 1 (POD1, E) vWF-Ag/ADAMTS13-AC ratio values to detect postoperative liver dysfunction (LD) are illustrated. ROC curve analysis includes the evaluation of its related area under the curve (AUC). Furthermore incidences of postoperative LD as well as severe morbidity and red-blood-cell transfusion (RBC-T) usage are shown in accordance to preOP (≥116, B–D) as well as POD1 (≥165, F–H) defined cut-off values of vWF-Ag/ADAMTS13-AC ratio. ^*P < 0.05, ^**P < 0.005.