Prediction of esophageal variceal bleeding in b-viral liver cirrhosis using the p2/ms noninvasive index based on complete blood counts

Beom Kyung Kim, Sang Hoon Ahn, Kwang Hyub Han, Jun Yong Park, Min Seok Han, Jung Hyun Jo, Ja Kyung Kim, Kwan Sik Lee, Chae Yoon Chon, Do Young Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background/Aim: Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e. medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. Methods: We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Results: Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS <9). The risk was significantly higher in subgroup 2 (p = 0.029). From multivariate analysis, a lower P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). Conclusions: The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9.

Original languageEnglish
Pages (from-to)264-272
Number of pages9
JournalDigestion
Volume86
Issue number3
DOIs
Publication statusPublished - 2012 Oct 1

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Blood Cell Count
Esophageal and Gastric Varices
Liver Cirrhosis
Hemorrhage
Endoscopy
Color
Varicose Veins
Platelet Count

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Kim, Beom Kyung ; Ahn, Sang Hoon ; Han, Kwang Hyub ; Park, Jun Yong ; Han, Min Seok ; Jo, Jung Hyun ; Kim, Ja Kyung ; Lee, Kwan Sik ; Chon, Chae Yoon ; Kim, Do Young. / Prediction of esophageal variceal bleeding in b-viral liver cirrhosis using the p2/ms noninvasive index based on complete blood counts. In: Digestion. 2012 ; Vol. 86, No. 3. pp. 264-272.
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title = "Prediction of esophageal variceal bleeding in b-viral liver cirrhosis using the p2/ms noninvasive index based on complete blood counts",
abstract = "Background/Aim: Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e. medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction ({\%}) × segmented neutrophil fraction ({\%})]. Methods: We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Results: Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS <9). The risk was significantly higher in subgroup 2 (p = 0.029). From multivariate analysis, a lower P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). Conclusions: The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9.",
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Prediction of esophageal variceal bleeding in b-viral liver cirrhosis using the p2/ms noninvasive index based on complete blood counts. / Kim, Beom Kyung; Ahn, Sang Hoon; Han, Kwang Hyub; Park, Jun Yong; Han, Min Seok; Jo, Jung Hyun; Kim, Ja Kyung; Lee, Kwan Sik; Chon, Chae Yoon; Kim, Do Young.

In: Digestion, Vol. 86, No. 3, 01.10.2012, p. 264-272.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of esophageal variceal bleeding in b-viral liver cirrhosis using the p2/ms noninvasive index based on complete blood counts

AU - Kim, Beom Kyung

AU - Ahn, Sang Hoon

AU - Han, Kwang Hyub

AU - Park, Jun Yong

AU - Han, Min Seok

AU - Jo, Jung Hyun

AU - Kim, Ja Kyung

AU - Lee, Kwan Sik

AU - Chon, Chae Yoon

AU - Kim, Do Young

PY - 2012/10/1

Y1 - 2012/10/1

N2 - Background/Aim: Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e. medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. Methods: We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Results: Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS <9). The risk was significantly higher in subgroup 2 (p = 0.029). From multivariate analysis, a lower P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). Conclusions: The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9.

AB - Background/Aim: Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e. medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. Methods: We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Results: Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS <9). The risk was significantly higher in subgroup 2 (p = 0.029). From multivariate analysis, a lower P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). Conclusions: The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9.

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