Validation of P2/MS and other noninvasive fibrosis scoring systems in the Korean population with nonalcoholic fatty liver disease.
OBJECTIVE
P2/MS is a noninvasive marker for detecting hepatic fibrosis in patients with viral hepatitis. However, the applicability of P2/MS in patients with nonalcoholic fatty liver disease (NAFLD) has not yet been validated. This study aimed to validate P2/MS and compare it to other noninvasive fibrosis scoring systems in Korean patients with NAFLD.


METHODS
Consecutive patients who underwent liver biopsy between January 2002 and December 2009 at Seoul National University Hospital, Seoul, Korea were enrolled in this study. Fibrosis stage was determined using the METAVIR scoring system.


RESULTS
A total of 235 patients were included in the study: advanced fibrosis (METAVIR F3-F4) was present in 7 patients. No patient was over-staged among 162 patients with a P2/MS score above the high cut-off (95), resulting in a high negative predictive value (NPV) of 100% (95% confidence interval, 97.1-100). There was no significant difference between the area under the receiver-operating characteristic curve (AUROC) of the FIB-4 (0.964) and the AUROC of the NAFLD fibrosis score (0.964) or P2/MS (0.940) for detecting advanced fibrosis. If P2/MS was implemented in the Korean patients with NAFLD, 68.9% of liver biopsies might be avoided.


CONCLUSIONS
P2/MS has a high NPV for excluding advanced fibrosis in Korean patients with NAFLD, and can reduce the burden of liver biopsy in the majority of cases. Since there were few patients with advanced fibrosis, further studies are warranted in a cohort including more patients with advanced fibrosis to validate the low cut-off value.
Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, Korea.
Su Jong
SJ
Yu
Dong Hee
DH
Kim
Jeong Hoon
JH
Lee
Goh Eun
GE
Chung
Jeong Yoon
JY
Yim
Min Jung
MJ
Park
Yoon Jun
YJ
Kim
Jung Hwan
JH
Yoon
Ja June
JJ
Jang
Hyo Suk
HS
Lee
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D001772:Blood Cell Count; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology; D009504:Neutrophils / Q000166:cytology; D065626:Non-alcoholic Fatty Liver Disease; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D056910:Republic of Korea; D012720:Severity of Illness Index
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase