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Background and aims <p>Esophageal varices (EV) are a frequent complication of liver cirrhosis and a leading cause of gastrointestinal bleeding and mortality. While upper gastrointestinal endoscopy is the preferred method for detecting EV, it may not be feasible in all settings. Non-invasive biomarkers could assist in identifying high-risk patients who should undergo prompt endoscopic evaluation. This study assessed the accuracy of the albumin-to-creatinine ratio (ACR) as a non-invasive predictor of EV in individuals with liver cirrhosis.</p> Methods <p>This cross-sectional observational study included 260 adult patients with liver cirrhosis who had not undergone endoscopic screening before. All patients underwent upper gastrointestinal endoscopy to screen for esophageal varices (EV). Demographic, clinical, and laboratory data were collected, and the albumin-to-creatinine ratio (ACR) was calculated from serum albumin and creatinine levels. Logistic regression analysis was used to identify independent predictors of EV. The diagnostic performance of ACR was assessed using receiver operating characteristic (ROC) curve analysis.</p> Results <p>Out of the 260 patients, 162 (62.3%) had EV. Patients with EV had significantly lower levels of ACR, serum albumin, platelet count, and hemoglobin, and higher levels of creatinine, bilirubin, INR, and MELD score compared to those without esophageal varices (all <i>p</i> &lt; 0.05). Logistic regression analysis revealed a significant inverse relationship between ACR and the presence of EV. lower ACR independently predicted the presence of EV (adjusted OR 0.53, 95% CI 0.41–0.68; <i>p</i> = 0.001). ROC analysis demonstrated that an ACR cutoff ≤ 3.12 predicted EV with 88% sensitivity, 55% specificity, and an area under the curve of 0.683 (<i>p</i> &lt; 0.001).</p> Conclusion <p>The ACR ratio is a cost-effective biomarker that can assist in identifying cirrhotic patients at higher risk of EV, aiding in the prioritization of endoscopic screening, especially in settings with limited resources.</p>

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Albumin-to-creatinine ratio as non-invasive marker for prediction of non- bleeding esophageal varices. a cross-sectional observational study

  • 期刊论文

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  • 发表日期：

    2026年7月10日

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  • Nasser Mousa,
  • Alaa Elmetwalli,
  • Mostafa abdelsalam,
  • Mohamed Wahba,
  • Niveen El-wakeel,
  • Marwa Mansour,
  • Mohamed Selim,
  • Muhammad Diasty,
  • Eman Abdelkader,
  • Adel El-Assmy,
  • Mohammed Abdelaziz,
  • Ali El-Assmy,
  • Ahmed Alhawarey

摘要

Background and aims

Esophageal varices (EV) are a frequent complication of liver cirrhosis and a leading cause of gastrointestinal bleeding and mortality. While upper gastrointestinal endoscopy is the preferred method for detecting EV, it may not be feasible in all settings. Non-invasive biomarkers could assist in identifying high-risk patients who should undergo prompt endoscopic evaluation. This study assessed the accuracy of the albumin-to-creatinine ratio (ACR) as a non-invasive predictor of EV in individuals with liver cirrhosis.

Methods

This cross-sectional observational study included 260 adult patients with liver cirrhosis who had not undergone endoscopic screening before. All patients underwent upper gastrointestinal endoscopy to screen for esophageal varices (EV). Demographic, clinical, and laboratory data were collected, and the albumin-to-creatinine ratio (ACR) was calculated from serum albumin and creatinine levels. Logistic regression analysis was used to identify independent predictors of EV. The diagnostic performance of ACR was assessed using receiver operating characteristic (ROC) curve analysis.

Results

Out of the 260 patients, 162 (62.3%) had EV. Patients with EV had significantly lower levels of ACR, serum albumin, platelet count, and hemoglobin, and higher levels of creatinine, bilirubin, INR, and MELD score compared to those without esophageal varices (all p < 0.05). Logistic regression analysis revealed a significant inverse relationship between ACR and the presence of EV. lower ACR independently predicted the presence of EV (adjusted OR 0.53, 95% CI 0.41–0.68; p = 0.001). ROC analysis demonstrated that an ACR cutoff ≤ 3.12 predicted EV with 88% sensitivity, 55% specificity, and an area under the curve of 0.683 (p < 0.001).

Conclusion

The ACR ratio is a cost-effective biomarker that can assist in identifying cirrhotic patients at higher risk of EV, aiding in the prioritization of endoscopic screening, especially in settings with limited resources.