Preoperative serum von Willebrand factor, E-selectin and tumor necrosis factor-alpha predict early venous outflow dysfunction after finger replantation
Preoperative serum biomarkers and early venous outflow dysfunction
Abstract
Background: Early venous outflow dysfunction is a leading cause of early failure after finger replantation. This study evaluated whether preoperative serum markers of endothelial activation and inflammation can predict early venous outflow dysfunction and developed a serum-based risk model.
Methods: This retrospective cohort included 150 patients who underwent finger replantation between January 2022 and October 2025. Peripheral venous blood was collected 2 h before surgery. Serum von Willebrand factor (vWF), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured. Early venous outflow dysfunction was defined as venous congestion requiring intervention within 72 h postoperatively. Independent markers were identified using multivariable logistic regression. Model performance was assessed by receiver operating characteristic analysis (AUC with 95% confidence intervals by the DeLong method and between-model comparison by the DeLong test), calibration by the Hosmer–Lemeshow test, and internal validation using bootstrap resampling (200 iterations).
Results: All seven biomarkers were higher in cases (n=74) than controls (n=76) (P<0.05) and were positively correlated with crisis duration (all P<0.01). vWF, E-selectin, and TNF-α remained independently associated with early venous outflow dysfunction. The resulting panel achieved an AUC of 0.811 (95% CI, 0.738–0.883), with 72.97% sensitivity and 84.21% specificity. Calibration was acceptable (Hosmer–Lemeshow P=0.093), and the optimism-corrected AUC was 0.802. A clinical-variable model showed poorer discrimination (AUC 0.618; 95% CI, 0.527–0.709), and the biomarker panel improved discrimination significantly (DeLong P=0.001).
Conclusions: A preoperative serum panel combining vWF, E-selectin, and TNF-α showed good discrimination for early venous outflow dysfunction after finger replantation. External validation is needed before routine clinical use.
Copyright (c) 2026 Feipeng Chen, Dexin Wang
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