External validation of P2/MS and comparison with other simple non-invasive indices for predicting liver fibrosis in HBV-infected patients.
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.
Kim
Beom Kyung
BK
Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seoul, 120-752, Korea.
Han
Kwang Hyub
KH
Park
Jun Yong
JY
Ahn
Sang Hoon
SH
Chon
Chae Yoon
CY
Kim
Ja Kyung
JK
Paik
Yong Han
YH
Lee
Kwan Sik
KS
Park
Young Nyun
YN
Kim
Do Young
DY
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
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase