Korean J Gastroenterol.  2011 Jan;57(1):19-27. 10.4166/kjg.2011.57.1.19.

Validation of P2/MS and Other Noninvasive Fibrosis Scoring Systems in the Korean Population with Nonalcoholic Fatty Liver Disease

• Yu SJ
• Kim D
• Lee JH
• Chung GE
• Yim JY
• Park MJ
• Kim YJ
• Yoon JH
• Jang JJ
• Lee HS

• KMID: 991464
• DOI: http://doi.org/10.4166/kjg.2011.57.1.19

Abstract

BACKGROUND/AIMS
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.

Keyword

Fatty liver; Nonalcoholic fatty liver disease; Liver fibrosis

MeSH Terms

Adult
Aged
Alanine Transaminase/blood
Area Under Curve
Aspartate Aminotransferases/blood
*Blood Cell Count
Diagnosis, Differential
Fatty Liver/complications/diagnosis/pathology
Female
Humans
Liver Cirrhosis/complications/*diagnosis/pathology
Male
Middle Aged
Monocytes/cytology
Neutrophils/cytology
Platelet Count
Predictive Value of Tests
ROC Curve
Republic of Korea
Severity of Illness Index

Figure

• 

  Fig. 1. Comparisons of the ROC of P2/MS and other noninvasive fibrosis scoring systems for the diagnosis of advanced fibrosis (defined as METAVIR F3-F4). (A) P2/MS versus FIB-4 and (B) P2/MS versus NAFLD fibrosis score.

• 

  Fig. 2. Scatter plot of noninvasive fibrosis scoring systems versus pathologically determined fibrosis stage. Fibrosis stage was determined using the METAVIR scoring system.25 Circles represent the values of each noninvasive fibrosis scoring systems. The solid line represents a trend-line. (A) P2/MS values showed a significant inverse correlation with the METAVIR fibrosis stage (Spearman's correlation coefficient=−0.127, p＜0.001), (B) FIB-4 scores showed a significant inverse correlation with the METAVIR fibrosis stage (Spearman's correlation coefficient=0.235, p＜0.001), (C) NAFLD fibrosis score values showed a significant inverse correlation with the METAVIR fibrosis stage (Spearman's correlation coefficient= 0.263, p＜0.001).

Reference

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