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

BACKGROUND: 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). OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: VWF/ADAMTS-13 ratios are not independent diagnostic markers for SIC but are independently associated with 28-day mortality in established SIC.