Editorial: von Willebrand factor and CRP levels may predict survival in liver cirrhosis—Authors’ reply

rocyte ischaemia, intestinal barrier dysfunction and bacterial translocation. Indeed a relationship between VWF and the pro-coagulant state (factor VIII/protein C ratio, P = 0.507; P < 0.001) is also present. This vicious circle may perpetuate the chronic systemic inflammation, independently from portal hypertension (Figure 1). Furthermore, as in previous reports, the authors find that VWF levels are associated with important clinical events in cirrhosis (variceal bleeding, paracentesis and bacterial infections) but, interestingly, this relationship is independent from patients’ HVPG. Finally, Mandorfer and coworkers develop a score including VWF > 367% and Reactive C Protein (CRP) > 6.5 mg/dL which identifies three groups of patients with different mortality. Patients in the intermediate or high risk groups show +80% and +259% increase in the mortality risk, respectively. This result suggests that endothelial dysfunction and systemic inflammation, as assessed by high levels of VWF and CRP, have a strong detrimental prognostic influence per se. This prognostic score obviously needs to be validated prospectively in an independent series of patients. If confirmed it could become a welcome noninvasive marker for prognosis in patients with cirrhosis.