Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B-viral cirrhosis.
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.
Kim
Beom Kyung
BK
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Han
Kwang-Hyub
KH
Park
Jun Yong
JY
Ahn
Sang Hoon
SH
Kim
Ja Kyung
JK
Paik
Yong Han
YH
Lee
Kwan Sik
KS
Chon
Chae Yoon
CY
Kim
Do Young
DY
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
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase