title: Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B-viral cirrhosis.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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 (%) x 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.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Ja Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Paik
authors.forename: Kwan Sik
authors.initials: KS
authors.lastname: Lee
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003430:Cross-Sectional Studies; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D007958:Leukocyte Count; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase