Prognostic value of von Willebrand factor and ADAMTS-13 in patients with sepsis-induced coagulopathy.

Authors

Feng Zhang, Yuting Li, Yanhua Li, Dong Zhang

Published in

Research and practice in thrombosis and haemostasis. Volume 10. Issue 5. Pages 106843. Epub Jul 14, 2026.

Abstract

The von Willebrand factor (VWF)- a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13 (ADAMTS-13) axis may contribute to microvascular thrombosis and poor outcomes in sepsis-induced coagulopathy (SIC).
The aim of this study was to characterize the VWF-ADAMTS-13 axis in SIC and evaluate whether VWF/ADAMTS-13 ratios are associated with SIC diagnosis and 28-day mortality.
In this prospective cohort study, 240 adult patients in the intensive care unit meeting Sepsis-3 criteria were consecutively enrolled at the First Hospital of Jilin University from February to October 2025. VWF antigen, factor VIII, ADAMTS-13 activity, and ADAMTS-13 antigen were measured within 24 hours of enrollment. VWF/ADAMTS-13 activity and antigen ratios were calculated. International Society on Thrombosis and Haemostasis SIC and overt disseminated intravascular coagulation scores were derived. The primary outcome was 28-day all-cause mortality. Associations were assessed using multivariable logistic regression, receiver operating characteristic curve analysis, and Kaplan-Meier survival analysis.
Overall, 152 patients (63.3%) met SIC criteria. Compared with non-SIC patients, SIC patients had lower ADAMTS-13 activity, higher VWF/ADAMTS-13 activity and antigen ratios, and higher 28-day mortality. After exclusion of variables included in the SIC score, VWF-ADAMTS-13 biomarkers were not independently associated with SIC diagnosis. Among patients with SIC, nonsurvivors had lower ADAMTS-13 activity and antigen levels but higher VWF/ADAMTS-13 ratios than survivors. In adjusted models, the VWF/ADAMTS-13 activity and antigen ratios were independently associated with 28-day mortality, with modest discriminatory ability (areas under the curve of 0.66 and 0.65, respectively). Mortality increased across VWF/ADAMTS-13 activity ratio quartiles.
VWF/ADAMTS-13 ratios are not independent diagnostic markers for SIC but are independently associated with 28-day mortality in established SIC.

PMID:
42568795
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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