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Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B-viral cirrhosis

Authors

  • Beom Kyung Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Kwang-Hyub Han,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    4. Brain Korea 21 Project for Medical Science, Seoul, Korea
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  • Jun Yong Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
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  • Sang Hoon Ahn,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
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  • Ja Kyung Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
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  • Yong Han Paik,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    4. Brain Korea 21 Project for Medical Science, Seoul, Korea
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  • Kwan Sik Lee,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
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  • Chae Yoon Chon,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
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  • Do Young Kim

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
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Correspondence
Do Young Kim, MD, Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea 120-752
Tel: +82 2 2228 1992
Fax: +82 2 393 6884
e-mail: dyk1025@yuhs.ac

Abstract

Backgrounds: 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.

Aims: 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 (%) × 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.

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