الفهرس 
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Abstract
Introduction: Liver cirrhosis is an important cause of morbidity and mortality. Esophageal varices and ascites are common complications of portal hypertension in irrhotic patients. Screening for varices by endoscopy is recommended in newly diagnosed cirrhotic patients. Screening of all patients with endoscopy increases the costs and results in overload on endoscopy units. Also, endoscopy is an invasive and unpleasant intervention to patients. Aim of the Study: This study was done to study the relation between serum-ascites albumin gradient (SAAG) and presence and grades of esophageal varices in chronic liver disease patients in order to validate the use of SAAG as a preliminary indirect parameter for presence of esophageal varices. Patients and Method: The study was done on 50 adult cirrhotic patients presenting with ascites, within 1 year from December 2017 to December 2018. All patients were evaluated for laboratory investigations, abdominal ultrasonography. Upper GI Endoscopy was done to all patients to determine the presence and grade of varices. Diagnostic paracentesis was done for Ascitic fluid examination and SAAG value was calculated. On the basis of SAAG value patients was divided into three groups: group 1 (SAAG 1.1-1.49), group 2 (SAAG 1.5-1.99) and group 3 (SAAG ≥2.0) RESULTS: There is significant difference between varices grade groups regarding platelets count. There is significant difference in the distribution of esophageal varices grades
between SAAG groups.
By regression analysis, there are three independent predictors of esophageal varices which are platelet count, SAAG level and Child-Pugh Classification class. Regarding the receiver operating characteristics (ROC) curve, it was found that at cut off value of SAAG of ≥1.5 the area under the curve (AUC) was 0.793 , the occurrence of varices can be predicted with 76% accuracy,<sensitivity of 77%, specificity of 75%, and positive predictive value of 97%
and negative predictive value of 22%. CONCLUSION: We found that there is a directly proportional significant relation between SAAG value and presence and severity of esophageal varices. Also, a cut off value of SAAG of ≥1.5 can be used for prediction of varices existence. Accordingly, SAAG can be used as an indirect noninvasive indicator for presence of varices.