External validation of P2/MS and comparison with other simple non-invasive indices for predicting liver fibrosis in HBV-infected patients

Beom Kyung Kim, Kwang Hyub Han, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Ja Kyung Kim, Yong Han Paik, Kwan Sik Lee, Young Nyun Park, Do Young Kim

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2 Citations (Scopus)


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. Aims: 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 ≥ 2) and severe (p ≥ 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.

Original languageEnglish
Pages (from-to)2636-2643
Number of pages8
JournalDigestive diseases and sciences
Issue number9
Publication statusPublished - 2010 Sep 1

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

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