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Prediction of esophageal variceal bleeding in B-viral liver cirrhosis using the P2/MS noninvasive index based on complete blood counts.

 Kim B.K.  ;  Ahn S.H.  ;  Han K.-H.  ;  Park J.Y.  ;  Han M.S.  ;  Jo J.H.  ;  Kim J.K.  ;  Lee K.S.  ;  Chon C.Y.  ;  Kim D.Y. 
 DIGESTION, Vol.86(3) : 264-272, 2012 
Journal Title
Issue Date
Blood Cell Count ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/diagnosis* ; Esophageal and Gastric Varices/epidemiology ; Esophageal and Gastric Varices/etiology ; Female ; Gastrointestinal Hemorrhage/blood ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology* ; Hepatitis B, Chronic/blood ; Hepatitis B, Chronic/complications* ; Hepatitis B, Chronic/diagnosis ; Humans ; Incidence ; Liver Cirrhosis/blood ; Liver Cirrhosis/complications* ; Liver Cirrhosis/diagnosis ; Male ; Middle Aged ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies
Liver cirrhosis ; Esophageal variceal bleeding ; Prediction ; Endoscopy ; P2/MS
BACKGROUND/AIM: Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e., medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. METHODS: We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. RESULTS: Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS <9). The risk was significantly higher in subgroup 2 (p = 0.029). From multivariate analysis, a lower P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). CONCLUSIONS: The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9.
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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
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)
Jo, Jung Hyun(조중현) ORCID logo https://orcid.org/0000-0002-2641-8873
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
Han, Min Seok(한민석)
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