The Ratio of von Willebrand Factor to ADAMTS13 May Improve Sarcopenia Identification in Patients with Liver Cirrhosis: A Retrospective Study

Aim: Sarcopenia is prevalent in patients with liver cirrhosis (LC) and associated with increased mortality and poor outcomes. However, readily available, noninvasive biomarkers for sarcopenia screening remain limited. This study evaluated the clinical utility of the von Willebrand factor (VWF)/a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) ratio as a biomarker for sarcopenia in patients with LC. Methods: We retrospectively analyzed 321 patients with LC. Sarcopenia was diagnosed according to the Japan Society of Hepatology criteria using computed tomography-derived skeletal muscle index and handgrip strength. ADAMTS13 and VWF levels were measured by enzyme-linked immunosorbent assay. Multivariate analyses identified factors associated with sarcopenia and overall survival. Results: Sarcopenia was diagnosed in 71 patients (22.1%). Patients with sarcopenia were older and had lower body mass index and hemoglobin levels. The VWF/ADAMTS13 ratio was significantly higher in patients with sarcopenia and negatively correlated with skeletal muscle index and handgrip strength. Multivariable logistic regression identified the VWF/ADAMTS13 ratio as an independent factor associated with sarcopenia (odds ratio 2.75, 95% confidence interval [CI]: 1.29–5.87, p < 0.01). A combined model including age, body mass index, hemoglobin, and VWF/ADAMTS13 ratio achieved an optimism-corrected area under the curve of 0.790 (95% CI: 0.730–0.850). Cox proportional hazards analysis demonstrated that an elevated VWF/ADAMTS13 ratio independently predicted poor overall survival (hazard ratio 1.67, 95% CI: 1.07–2.61, p < 0.05). Conclusions: The VWF/ADAMTS13 ratio was significantly associated with sarcopenia and may serve as a useful biomarker for its screening and identification in patients with LC.