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External validation of P2/MS and comparison with other simple non-invasive indices for predicting liver fibrosis in HBV-infected patients

 Beom Kyung Kim  ;  Kwang Hyub Han  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Chae Yoon Chon  ;  Ja Kyung Kim  ;  Yong Han Paik  ;  Kwan Sik Lee  ;  Young Nyun Park  ;  Do Young Kim 
 DIGESTIVE DISEASES AND SCIENCES, Vol.55(9) : 2636-2643, 2010 
Journal Title
Issue Date
Adult ; Age Factors ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Biopsy, Needle ; Cross-Sectional Studies ; Female ; Health Status Indicators* ; Hepatitis B/blood ; Hepatitis B/complications ; Hepatitis B/diagnosis* ; Hepatitis B/diagnostic imaging ; Humans ; Leukocyte Count ; Liver Cirrhosis/blood ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/etiology ; Male ; Middle Aged ; Models, Statistical* ; Monocytes ; Neutrophils ; Platelet Count ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; Severity of Illness Index ; Ultrasonography
P2/MS ; Chronic hepatitis B ; Cirrhosis ; Liver biopsy ; Prediction ; Validation
BACKGROUND: To optimize management strategies and predict the long-term clinical course in patients with chronic hepatitis B (CHB), non-invasive tests to determine the degree of hepatic fibrosis have been developed. AIMS: We aimed to conduct a large-scale external validation of a simple, non-invasive test called P2/MS using CHB patients and to compare it to other non-invasive tests for the prediction of histological cirrhosis. METHODS: From 2006 to 2009, we enrolled a total of 521 consecutive CHB patients who underwent liver biopsy. Fibrosis stage was assessed according to the Metavir scoring system by a single pathologist who was unaware of the patients' histories. RESULTS: For predictions of significant (p>or=2) and severe (p>or=3) fibrosis and cirrhosis (p=4), the areas under the receiver operating characteristic curves were 0.801, 0.856, and 0.906, respectively. In predicting cirrhosis, we found that diagnostic values were comparable to age-spleen platelet ratio index (0.931, p=0.063), spleen-platelet ratio index (0.923, p=0.145), age-platelet index (0.914, p=0.670), and FIB-4 (0.898. p=0.597) and had better outcomes than the aspartate aminotransferase (AST)-platelet ratio index (0.780, p<0.001), and AST-alanine aminotransferase ratio index (0.729, p<0.001). The cut-off points of P2/MS>83 and P2/MS<30 provided 91.1% of negative predictive value and 91.3% of positive predictive value, respectively. Based on these results, liver biopsies could be avoided in 67.0% of the population. These cut-offs were validated internally using bootstrap resampling methods, which showed good agreement. CONCLUSIONS: P2/MS is a simple, accurate, and inexpensive method with comparable outcomes to other non-invasive tests and may reduce the need for liver biopsy in the majority of CHB patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 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, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
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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