VITRO score (VWF/platelet ratio)
Non-invasive estimate of clinically significant portal hypertension in compensated advanced chronic liver disease
- Developed in Linz and Vienna
- ÖGGH/ÖGIR Billroth IV consensus 2023
Sources last checked: 2026-10-13
VITRO score (VWF/platelet ratio)
Non-invasive estimate of clinically significant portal hypertension in compensated advanced chronic liver disease
For compensated advanced chronic liver disease (cACLD) only. VWF rises with infection, inflammation, malignancy and in pregnancy, which can produce false-positive values; platelet counts are affected by drugs and haematological disease. Assay calibration for VWF:Ag differs between laboratories. A ruled-in result does not replace endoscopy where variceal screening is indicated.
Interpretation
| < 1.0 — CSPH unlikely | Billroth IV: VITRO < 1 rules out CSPH when transient elastography is not available (limited evidence). |
|---|---|
| 1.0–1.5 — CSPH ruled out only after an unclassified Baveno VII result | In patients left 'unclassified' by Baveno VII (LSM/platelets), VITRO ≤ 1.5 ruled out CSPH (sensitivity 97.7 %, NPV 97.5 %; Jachs 2023). Used alone (no elastography), this range is indeterminate. |
| 1.51–2.49 — indeterminate | Neither rule-out nor rule-in. For this situation Billroth IV names HVPG measurement and/or endoscopy for varices as further evaluation. |
| ≥ 2.5 — CSPH likely (ruled in) | VITRO ≥ 2.5 ruled in CSPH in Baveno VII-unclassified patients (specificity 94.7 %, PPV 91.2 %; Jachs 2023); Billroth IV uses > 2.5 when elastography is not available. Implications for NSBB therapy and screening endoscopy per Baveno VII/Billroth IV. |
What is the VITRO score (VWF/platelet ratio)?
The VITRO score is the ratio of von Willebrand factor antigen (%) to platelet count (G/L). VWF rises with portal hypertension and endothelial activation while platelets fall with hypersplenism, so the ratio tracks hepatic venous pressure gradient. Hametner and colleagues in Linz and Vienna showed it detected clinically significant portal hypertension (HVPG ≥ 10 mmHg) with an AUC of 0.86 (PLoS One 2016), and the Austrian Billroth IV consensus recommends it when elastography is unavailable or inconclusive.
When to use it
- Compensated advanced chronic liver disease when transient elastography is not available.
- Patients left 'unclassified' by Baveno VII liver-stiffness/platelet criteria.
- Monitoring progression or regression of portal hypertension (e.g. every 12 months) when elastography is not possible.
When not to use it
- Decompensated cirrhosis, where CSPH is already present.
- Active infection, sepsis or marked inflammation, which raise VWF.
- Haematological disease or drugs that alter platelet counts independently of the liver.
How it is calculated
VITRO = VWF:Ag (%) ÷ platelet count (G/L)
Clinical pearls and limitations
- For compensated advanced chronic liver disease (cACLD) only. VWF rises with infection, inflammation, malignancy and in pregnancy, which can produce false-positive values; platelet counts are affected by drugs and haematological disease. Assay calibration for VWF:Ag differs between laboratories. A ruled-in result does not replace endoscopy where variceal screening is indicated.
- Units matter: VWF:Ag in % of normal, platelets in G/L (10⁹/L).
- Jachs 2023 cut-offs (within Baveno VII grey zone): ≤ 1.5 rules out, ≥ 2.5 rules in CSPH.
- Billroth IV (without elastography): < 1 rules out, > 2.5 rules in.
- VWF also predicts decompensation and mortality, and falls with effective NSBB therapy.
Frequently asked questions
How is the VITRO score calculated?
Divide VWF:Ag (%) by the platelet count (G/L). Example: 240 % ÷ 120 G/L = 2.0.
What VITRO value indicates portal hypertension?
A VITRO ≥ 2.5 rules in clinically significant portal hypertension in Baveno VII-unclassified patients; < 1 (Billroth IV) or ≤ 1.5 (after an unclassified Baveno VII result) rules it out.
Is the VITRO score recommended in Austria?
Yes. The ÖGGH/ÖGIR Billroth IV consensus (2023) lists VITRO as the alternative non-invasive test for CSPH and for reclassifying Baveno VII grey-zone patients.
Evidence and guidelines
- Primary source: Hametner S, Ferlitsch A, Ferlitsch M et al. The VITRO score (von Willebrand factor antigen/thrombocyte ratio) as a new marker for clinically significant portal hypertension in comparison to other non-invasive parameters of fibrosis including ELF test. PLoS One 2016;11(2):e0149230.
- Reiberger T et al. Austrian consensus on the diagnosis and management of portal hypertension in advanced chronic liver disease (Billroth IV). Wien Klin Wochenschr 2023;135(Suppl 3):493-523.
- Jachs M, Hartl L, Simbrunner B et al. The sequential application of Baveno VII criteria and VITRO score improves diagnosis of clinically significant portal hypertension. Clin Gastroenterol Hepatol 2023;21(7):1854-1863.e10.
- de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII — Renewing consensus in portal hypertension. J Hepatol 2022;76(4):959-974.
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the VITRO score (VWF/platelet ratio)Related calculators
Embed this calculatorFree to use on your website, intranet or teaching page. Copy the code below.
<iframe src="https://medelix.ai/en/embed/vitro-score" title="VITRO score (VWF/platelet ratio) – Medelix" width="100%" height="620" style="border:0;max-width:720px" loading="lazy"></iframe>
<p><a href="https://medelix.ai/en/calculators/vitro-score">VITRO score (VWF/platelet ratio) calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.