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

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

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)860-866
Number of pages7
JournalLiver International
Issue number6
Publication statusPublished - 2010 Jul

All Science Journal Classification (ASJC) codes

  • Hepatology


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