# Leucine Aminopeptidase to Spleen Length Ratio: A Novel Noninvasive Model for Predicting Esophageal Gastric Variceal Bleeding in Patients With Liver Cirrhosis

## TL;DR

This study introduces a noninvasive model using blood and spleen measurements to predict esophageal gastric variceal bleeding in liver cirrhosis patients.

## Contribution

The novel LAP/spleen length ratio (LSR) and its combination with total protein improve noninvasive prediction of bleeding risk.

## Key findings

- LSR and TP combination showed highest diagnostic accuracy for predicting EGVB.
- NEU% and splenic vein diameter are independent risk factors for EGVB.
- TP, TBA, LAP, and PLT are protective factors against EGVB.

## Abstract

Esophageal gastric variceal bleeding (EGVB) is a common complication of liver cirrhosis. However, esophagogastroduodenoscopy (EGD) for detecting venous pressure is invasive, limiting its clinical application. To reduce unnecessary EGD screening, here we screened multiple commonly used noninvasive examination indicators and evaluated their potential for predicting the risk of EGVB in patients with cirrhosis.

Patients with liver cirrhosis who were diagnosed with esophageal gastric varices (EGVs) for the first time were divided into groups with and without bleeding. All patients underwent serum biochemical and hematological tests, EGD, and splenic ultrasound examination. The relationships among these indices and EGVB were analyzed using logistic regression models and receiver operating characteristic (ROC) curves.

The neutrophil‐to‐leukocyte ratio (NEU%) and splenic vein diameter were identified as independent risk factors for EGVB, while total protein (TP), total biliary acid (TBA), leucine aminopeptidase (LAP), and platelet (PLT) count were protective factors. TP, TBA, NEU%, LAP/spleen length ratio (LSR), and PLT/spleen length ratio (PSR) were all significantly correlated with the maximum diameter of EGV blood vessels. Compared to their individual applications, the combination of TP and LSR demonstrated the highest diagnostic accuracy for EGVB.

LSR and the combination application of LSR and TP could help predict bleeding events in patients with EGV.