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Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B‐viral cirrhosis
Author(s) -
Kim Beom Kyung,
Han KwangHyub,
Park Jun Yong,
Ahn Sang Hoon,
Kim Ja Kyung,
Paik Yong Han,
Lee Kwan Sik,
Chon Chae Yoon,
Kim Do Young
Publication year - 2010
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2010.02260.x
Subject(s) - medicine , gastroenterology , receiver operating characteristic , cirrhosis , prospective cohort study , cutoff , esophageal varices , platelet , endoscopy , predictive value of tests , varices , portal hypertension , physics , quantum mechanics
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 (%) × 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.