Refining Risk Stratification for Oesophageal Varices in HCV ‐Related Cirrhosis: A Comprehensive Analysis of the Albumin Platelet Product and Elastography Biomarkers

The albumin platelet product (APP) has recently been explored as a non-invasive marker of liver fibrosis, but its potential to predict portal hypertension and oesophageal varices (OVs) remains under-evaluated. This study aimed to assess the diagnostic accuracy of APP in predicting and grading OVs in cirrhotic patients and to compare its performance with established serum indices and elastography-based measures. A total of 372 patients with HCV-related liver cirrhosis underwent upper endoscopy for OV assessment. APP was calculated and evaluated alongside liver stiffness (LS), spleen stiffness (SS), aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4). In the derivation cohort, APP demonstrated an AUROC of 0.80 (95% CI: 0.75-0.86) for detecting OVs, comparable to LS (0.82; 95% CI: 0.76-0.88) and superior to SS (0.78; 95% CI: 0.71-0.84), FIB-4 (0.68; 95% CI: 0.61-0.74) and APRI (0.66; 95% CI: 0.60-0.72). In the validation cohort, APP maintained a robust performance (AUROC 0.79; 95% CI: 0.73-0.85), confirming reproducibility. For high-risk (large) varices, APP achieved an AUROC of 0.87 (95% CI: 0.82-0.93), outperforming LS (0.83; 95% CI: 0.77-0.89) and SS (0.85; 95% CI: 0.79-0.91). Accordingly, the APP demonstrates superior accuracy over liver and spleen stiffness in predicting oesophageal varices among patients with HCV-related cirrhosis, offering a cost-effective, non-invasive alternative within this population.