A dual-threshold scoring system that leverages serum pepsinogen I and serum albumin levels enhances the accuracy of peptic ulcer screening

Background and purpose: Peptic ulcer (PU) is a common chronic disease of the gastrointestinal tract. Despite the decline in the occurrence of PU due to effective Helicobacter pylori (HP) eradication and proton pump inhibitor (PPI) treatment, PU continues to be a leading cause of upper gastrointestinal bleeding. There is a pressing requirement for an accessible, minimally invasive, and cost-effective screening tool. This research aims to investigate the efficacy of a novel scoring system that considers serum pepsinogen I (PGI) and serum albumin (ALB) levels—PGI ALB Composite Score (PACS)—in screening high-risk groups for PU. Methods: This research analyzed patient data retrospectively from January 2019 to June 2020 at our institution, focusing on gastrointestinal mucosal evaluations. Clinical profiles, including complete blood count, pepsinogen (PG) levels, G-17, and HP antibody status, were assembled. Endoscopies provided insights into mucosal morphology. We introduced a dual-threshold scoring system PACS. Its efficacy in detecting PU was gauged through receiver operating characteristic curve analysis. Results: Our analysis encompassed 902 subjects, with 204 suffering from PU. Notably, male gender, the use of antiplatelet and anti-inflammatory drugs, higher levels of PGI and lower levels of ALB were significantly associated with the presence of PU, as determined by both univariate and multivariate logistic regression ( p <0.05). The dual-threshold scoring system, PACS, integrating these biomarkers, demonstrated superior screening performance with an area under the curve (AUC) of 0.774 ( p <0.001), outperforming individual markers such as PGI (AUC: 0.743) and ALB (AUC: 0.713). The risk of PU increased markedly with higher PACS scores (PACS: 0 vs 1 vs 2 = 7.9% vs 28.6% vs 62.2%, p <0.001). Conclusion: The PACS system, utilizing both PGI and ALB, proposed in this study outperforms single biomarkers in diagnosing high-risk groups for PU. This system demonstrates higher screening accuracy and considerable clinical utility for PU.