title: External validation of P2/MS and comparison with other simple non-invasive indices for predicting liver fibrosis in HBV-infected patients.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors: Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seoul, 120-752, Korea.
authors: Beom Kyung
authors: BK
authors: Kim
authors: Kwang Hyub
authors: KH
authors: Han
authors: Jun Yong
authors: JY
authors: Park
authors: Sang Hoon
authors: SH
authors: Ahn
authors: Chae Yoon
authors: CY
authors: Chon
authors: Ja Kyung
authors: JK
authors: Kim
authors: Yong Han
authors: YH
authors: Paik
authors: Kwan Sik
authors: KS
authors: Lee
authors: Young Nyun
authors: YN
authors: Park
authors: Do Young
authors: DY
authors: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001707:Biopsy, Needle; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006509:Hepatitis B / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009000:Monocytes; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase