Prediction of Esophageal Varices Based on Serum-Ascites Albumin Gradient in Cirrhotic Patients

Background: Ascites and esophageal varices (EV) are the most common complications of portal hypertension, with an incidence of approximately 50%. Since effective preventive modalities have been established for variceal hemorrhage, early detection of EV is critical for primary prevention of bleeding. Serum-ascites albumin gradient (SAAG) can be considered an indirect parameter for the detection of EV and is useful in regions where there is a shortage of human and material resources to perform upper gastrointestinal endoscopy (UGE). The aim was to evaluate the role of serum-ascites albumin gradient (SAAG) in the prediction of esophageal varices (EV) in cirrhotic patients with ascites. Methods: All cirrhotic patients with ascites, identified by ultrasonography, who underwent measurement of SAAG, were included in this study. All patients underwent upper gastrointestinal endoscopy (UGE) for assessment of the presence and size of EV. Results: The study included 80 cirrhotic patients with ascites. The main causes of cirrhosis were alcohol intake (37.5%), hepatitis B virus (25.0%), and hepatitis C virus (15.0%). Patients with SAAG values > 1.75 g/dL demonstrated EV with a sensitivity and specificity of 78.4% and 83.3%, respectively. SAAG values > 1.8 g/dL were associated with the risk of large EV with AUC of 0.856, sensitivity of 88.24%, and specificity of 50.79%. The correlation coefficient (r) between SAAG and EV was 0.429, which was statistically significant (p < 0.001). Conclusions: Cirrhotic patients with SAAG values ≥ 1.8 have a higher risk of large EV. In particular, those with values > 1.9 who have higher possibility of bleeding must undergo upper GI endoscopy.