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.