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

A dual-threshold scoring system that leverages serum pepsinogen I and serum albumin levels enhances the accuracy of peptic ulcer screening | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A dual-threshold scoring system that leverages serum pepsinogen I and serum albumin levels enhances the accuracy of peptic ulcer screening YIli Feng, Haiyan Qin, Xianwei Cao, Min Xu, Chaoqun Hou, Zhiquan Qian, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2312636/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract 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. Health sciences/Gastroenterology Health sciences/Medical research Health sciences/Neurology pepsinogen I peptic ulcer gastrointestinal bleeding antiplatelet drugs serum albumin Figures Figure 1 Full Text Additional Declarations The authors declare no competing interests. Supplementary Files SupplementalTables.docx Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2312636","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":620349417,"identity":"e66679ba-7798-413a-9b17-6ed4fc7bb461","order_by":0,"name":"YIli Feng","email":"","orcid":"","institution":"Department of Neurology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":false,"prefix":"","firstName":"YIli","middleName":"","lastName":"Feng","suffix":""},{"id":620349418,"identity":"8800cd70-cc7c-4389-9907-1d2fdcbd6d24","order_by":1,"name":"Haiyan Qin","email":"","orcid":"","institution":"Department of Neurology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":false,"prefix":"","firstName":"Haiyan","middleName":"","lastName":"Qin","suffix":""},{"id":620349419,"identity":"4f29161b-c5e4-40a8-92af-87e5206ca72c","order_by":2,"name":"Xianwei Cao","email":"","orcid":"","institution":"Department of Gastroenterology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":false,"prefix":"","firstName":"Xianwei","middleName":"","lastName":"Cao","suffix":""},{"id":620349420,"identity":"6b0f7473-604a-4da3-8453-aa2b64858eb8","order_by":3,"name":"Min Xu","email":"","orcid":"","institution":"Department of Neurology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Xu","suffix":""},{"id":620349421,"identity":"22347800-9673-477b-8a84-e8fef33fc189","order_by":4,"name":"Chaoqun Hou","email":"","orcid":"","institution":"Department of Neurology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":false,"prefix":"","firstName":"Chaoqun","middleName":"","lastName":"Hou","suffix":""},{"id":620349422,"identity":"a8eb02bd-d6e8-409a-b54d-c2687b2c4ac7","order_by":5,"name":"Zhiquan Qian","email":"","orcid":"","institution":"Department of Neurology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":false,"prefix":"","firstName":"Zhiquan","middleName":"","lastName":"Qian","suffix":""},{"id":620349423,"identity":"497ac4c4-fba4-4606-b24c-52efdca1958a","order_by":6,"name":"Binli Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYDACCcYGhgcGNnL27Y2NDz4QrSWhIM3YgOdws+EM4rQAccKHw4kbJNLbpDmI0WFwu7ntQYLBYWNzyYcN0gwMdnK6DYS03DnYbpBgkC5nOTuxwbiAIdnY7AABLWY3EtskEgysjRluJzYkz2A4kLiNSC3MiQ03DzYc5iFBi3PihhuMjc1EabG/cxCkJc1YsiexmXGGARF+kZzd/kziwx8bOX72489/fKiwkyOoBQ0YkKZ8FIyCUTAKRgEOAACdekiKQqUUQAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-9183-637X","institution":"Department of Neurology, Huzhou Nanxun District People's Hospital, Zhejiang Provincial People's Hospital Nanxun District, Huzhou, China","correspondingAuthor":true,"prefix":"","firstName":"Binli","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2022-11-25 13:14:21","currentVersionCode":2,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-2312636/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-2312636/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106642445,"identity":"3591ff35-11ca-44bb-9507-089082acd5b2","added_by":"auto","created_at":"2026-04-10 18:39:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91388,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of PU, DU and GU under different PACS scores.\u003c/p\u003e\n\u003cp\u003e** indicated that \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003ePU, peptic ulcer; DU, Duodenal ulcer; GU, Gastric ulcer.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2312636/v2/71a2f679903b086378a2ecfd.jpg"},{"id":106994597,"identity":"61780662-7ea9-4e9b-b4f3-27a750a2be33","added_by":"auto","created_at":"2026-04-15 15:14:21","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":523981,"visible":true,"origin":"","legend":"","description":"","filename":"RevisedManuscriptv2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2312636/v2_covered_b1fc80d0-d15d-4e68-b9a4-d9aebb76eefc.pdf"},{"id":106993572,"identity":"bb5b0f28-c1b6-46ab-b4aa-6e8d2ce5347a","added_by":"auto","created_at":"2026-04-15 14:37:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24735,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-2312636/v2/2c138c3bc057289d95090914.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"A dual-threshold scoring system that leverages serum pepsinogen I and serum albumin levels enhances the accuracy of peptic ulcer screening","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pepsinogen I, peptic ulcer, gastrointestinal bleeding, antiplatelet drugs, serum albumin","lastPublishedDoi":"10.21203/rs.3.rs-2312636/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2312636/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and purpose:\u003c/strong\u003e\u0026nbsp;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\u0026nbsp;the efficacy of a\u0026nbsp;novel scoring\u0026nbsp;system that considers serum pepsinogen I (PGI) and serum albumin (ALB) levels—PGI ALB Composite Score (PACS)—in screening high-risk groups for PU.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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)\u0026nbsp;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOur 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\u0026nbsp;were significantly associated with the presence of PU,\u0026nbsp;as determined by both univariate and multivariate logistic regression (\u003cem\u003ep\u003c/em\u003e\u0026lt;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 (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), outperforming individual markers such as PGI (AUC:\u0026nbsp;0.743) and ALB (AUC:\u0026nbsp;0.713). The risk of PU increased markedly with higher PACS scores\u0026nbsp;(PACS:\u0026nbsp;0 vs 1 vs 2 = 7.9% vs 28.6% vs 62.2%, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe 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\u0026nbsp;and\u0026nbsp;considerable clinical utility\u0026nbsp;for PU.\u003c/p\u003e","manuscriptTitle":"A dual-threshold scoring system that leverages serum pepsinogen I and serum albumin levels enhances the accuracy of peptic ulcer screening","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2026-04-10 18:39:21","doi":"10.21203/rs.3.rs-2312636/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2022-12-28 15:26:57","doi":"10.21203/rs.3.rs-2312636/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7d4a10f-aa0b-4c13-a4ba-9d1fe9cedd68","owner":[],"postedDate":"April 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":66018548,"name":"Health sciences/Gastroenterology"},{"id":66018549,"name":"Health sciences/Medical research"},{"id":66018550,"name":"Health sciences/Neurology"}],"tags":[],"updatedAt":"2026-04-09T13:19:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-10 18:39:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-2312636","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2312636","identity":"rs-2312636","version":["v2"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}