"Noninvasive predictive marker for esophageal variceal bleeding".

OBJECTIVE: Esophageal varices are common in cirrhosis with portal hypertension; some patients face high risk of life-threatening esophageal variceal bleeding (EVB). Because few noninvasive markers predict EVB, this study sought to identify accessible predictors. METHODS: From 2002 to 2018, 336 patients with high-risk or hemorrhagic esophageal varices were studied: 72 with recent variceal rupture/bleeding (EVB) and 264 without (EVNB). The study evaluated associations between EVB and several clinical scores and biomarkers, focusing on sarcopenia, Controlling Nutritional Status (CONUT) score, and neutrophil-to-lymphocyte ratio (NLR), alongside established indices. RESULTS: Comparisons and univariate analyses were performed for MELD, CONUT, sarcopenia, fibrosis index, FIB-4, AST/ALT ratio, ALBI, and APRI between EVB and EVNB groups. Multivariate analysis identified the Neutrophil/Lymphocyte ratio (NLR) and CONUT score were identified as independent predictors associated with EVB. The CONUT score and NLR achieved AUROCs values were 0.75 and 0.65, with optimal cut-offs at 4.5 and 3.87, respectively. Notably, 58/72 (80.6%) EVB patients had CONUT > 4.5 and 31/72 (43.1%) had NLR > 3.87. CONCLUSIONS: Comparing several noninvasive biomarkers and scoring systems, the study suggests CONUT ≥ 4.5 and NLR ≥ 3.87 as potential predictors of esophageal variceal bleeding. Because CONUT and NLR are routinely available and showed acceptable predictive performance, they may be practical tools for risk stratification in patients at risk for EVB.