Elevated baseline von Willebrand factor levels indicate greater disease severity and predict treatment failure in diabetic retinopathy

Background. The search for systemic biomarkers capable of reflecting the activity of diabetic retino­pathy (DR) and predicting adverse treatment outcomes is an important clinical task of modern ophthalmology. Of particular interest is von Willebrand factor (vWF), which is a marker of endothelial dysfunction. Therefore, our aim was to evaluate the association of baseline vWF levels with the stage of DR and treatment failure, defined as rapid DR progression within 2 years, as well as to establish its potential prognostic utility in patients with type 2 diabetes mellitus (T2DM). Materials and methods. The study analyzed data from 136 T2DM patients with DR. DR stages were classified according to the WHO criteria as non-proliferative, pre-proliferative, and proliferative DR. The association of vWF with disease progression was assessed using ordinal and binary logistic regression models, adjusted for clinical confounders (age, sex, T2DM duration, glycated hemoglobin (HbA1c), systolic blood pressure, and baseline active ophthalmic treatment). Predictive utility was determined via ROC analysis with repeated stratified 5-fold cross-validation (50 repeats). Results. The presence of treatment failure was observed in 58.1 % of cases. vWF levels consistently increased with DR severity: 16.37 µg/mL in non-proliferative, 30.66 µg/mL in pre-proliferative, and 41.49 µg/mL in proliferative DR (p < 0.001). In treatment failure, vWF levels were significantly higher (34.26 µg/mL) compared to its absence (18.01 µg/mL; p < 0.001). In adjusted models, a 1 µg/mL increase in vWF independently increased the odds of a more severe DR stage (OR 1.23; p < 0.001) and treatment failure (OR 1.19; p < 0.001). The area under the ROC curve was 0.846; an optimal cut-off of 29.37 µg/mL yielded a sensitivity of 64.6 % and a specificity of 93.0 %. Conclusions. Baseline vWF levels demonstrate a consistent association with DR severity and represent a clinically relevant predictor for risk stratification of treatment failure in patients with T2DM.