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Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B-viral cirrhosis

 Beom Kyung Kim  ;  Kwang-Hyub Han  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Ja Kyung Kim  ;  Yong Han Paik  ;  Kwan Sik Lee  ;  Chae Yoon Chon  ;  Do Young Kim 
 LIVER INTERNATIONAL, Vol.30(6) : 860-866, 2010 
Journal Title
Issue Date
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Biomarkers/blood ; Biopsy ; Cross-Sectional Studies ; Endoscopy ; Esophageal and Gastric Varices/blood ; Esophageal and Gastric Varices/diagnosis* ; Esophageal and Gastric Varices/virology ; Female ; Hepatitis B, Chronic/complications* ; Humans ; Leukocyte Count* ; Liver/pathology ; Liver Cirrhosis/blood ; Liver Cirrhosis/virology* ; Male ; Middle Aged ; Monocytes ; Neutrophils ; Platelet Count* ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; Spleen/diagnostic imaging ; Ultrasonography
cirrhosis ; endoscopy ; oesophageal varix ; P2/MS ; prediction
BACKGROUNDS: Periodic endoscopic screening for oesophageal varices (OVs) and prophylactic treatment for high-risk OVs (HOVs; medium/large OVs or small OVs plus red sign/decompensation) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may reliably avoid endoscopy. AIMS: We conducted a large-scale validation study of a simple, noninvasive test called P2/MS based on complete blood counts, (platelet count)(2)/[monocyte fraction (%) x segmented neutrophil fraction (%)], and compared it with other predictive tests for HOVs in B-viral cirrhotic patients. METHODS: From 2008 to 2009, we prospectively enrolled 318 consecutive B-viral cirrhotic patients. All underwent endoscopy and laboratory evaluation. RESULTS: An area under the receiver operating characteristic curve of P2/MS was 0.941 for HOVs, comparable with those of the age-spleen platelet ratio index (0.922, P=0.317) and spleen-platelet ratio index (0.922, P=0.324), and better than those of age-platelet index (0.653, P<0.001), aspartate aminotransferase (AST)-platelet ratio index (0.871, P<0.006) and AST-alanine aminotransferase ratio (0.644, P<0.001). P2/MS<11 reliably identified 83 patients as having HOVs (94.0% positive predictive value), while at a cutoff of 25 and 179 as not having HOVs (94.4% negative predictive value). Overall, P2/MS reliably determined the likelihood of HOVs in 262 patients (82.4%). These cutoffs were validated internally using bootstrap resampling methods, which showed good agreement. CONCLUSIONS: P2/MS is a simple, accurate and economical method, reducing the need for endoscopy in B-viral cirrhosis. Patients with P2/MS<11 should be considered for appropriate prophylactic treatments, while those with P2/MS>25 may avoid endoscopy reliably
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Paik, Yong Han(백용한)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Kwan Sik(이관식) ORCID logo https://orcid.org/0000-0002-3672-1198
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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