VExUS Ultrasound-Based Noninvasive Risk Stratification Model for Esophageal Variceal Bleeding in Cirrhosis

Background Esophageal variceal bleeding (EVB) is a life-threatening complication of cirrhosis, necessitating accurate risk stratification. Current non-invasive methods lack sensitivity to dynamic hemodynamic changes. This study aimed to develop a VExUS ultrasound-based model integrating renal venous congestion and superior mesenteric artery (SMA) hemodynamics for noninvasive EVB risk prediction. Materials and Methods This retrospective study enrolled 161 patients with liver cirrhosis. Based on endoscopic findings, participants were stratified into two groups: those receiving endoscopic band ligation (EBL) (±pharmacotherapy) (n=78, 48.4%) and those managed conservatively (n=83, 51.6%). VExUS parameters, including renal vein Doppler patterns and superior mesenteric artery (SMA) peak systolic velocity (PSV), were analyzed alongside liver function markers. Using endoscopic results as the reference standard, we developed a predictive model for high-risk esophageal varices.The study protocol was approved by the Institutional Ethics Committee (No. XJTU1AF2024LSYY-339) and complied with the Declaration of Helsinki. Results The combination model (renal venous congestion + SMA-PSV + ALT) achieved an AUC of 0.931 (95% CI: 0.8916–0.9703), significantly outperforming individual parameters (p<0.01). Renal venous congestion alone showed an AUC of 0.841 (95% CI: 0.7745–0.9066). Conclusion The VExUS-based model provides a noninvasive, accurate tool for EVB risk stratification, potentially reducing reliance on endoscopy.