Background <p>The development of esophageal varices is an important consequence of portal hypertension. In accordance with the Baveno VI consensus, noninvasive tools are recommended to stratify patients and to identify those who are at risk of high-risk esophageal varices (HREV), for whom endoscopic assessment is warranted.</p> Aim of the study <p>To investigate the diagnostic value of serum kallistatin levels, along with other biochemical panels, in the assessment of portal hypertension among Egyptian individuals with liver cirrhosis.</p> Methods <p>This cross-sectional research evaluated 90 cirrhotic cases who were admitted to the National Liver Institute’s Hepatology and Gastroenterology Department as well as the Endoscopy Unit at Menoufia University by measuring the serum KAL level and comparing it to other panels in order to grade esophageal varices according to the results of GI endoscopy.</p> Results <p>The mean age of the 90 individuals who were enrolled in the study was 59.8 ± 9.8 years; 42.2% of them were female, and 57.8% were male. Patients with varices had a considerably decreased mean level of blood kallistatin. Additionally, it demonstrates a notable decrease in individuals with extensive varices. The presence of EV can be predicted by kallistatin with a sensitivity of 76.5% and a specificity of 98.6% at cut-off levels of 23.1 µg/ml.</p> Conclusion <p>Serum kallistatin may serve as a potential indicator for identifying esophageal varices, particularly the larger and more life-threatening types.</p>