Comparative Accuracy of Clinical and Inflammatory Scores for Predicting Mortality and Rebleeding After Acute Gastroesophageal Variceal Bleeding.

Background/

Objectives

Acute gastroesophageal variceal bleeding (AGEVB) is a major cause of mortality and treatment failure in cirrhotic patients. Early risk stratification remains essential for optimizing management and intensive monitoring. To compare the prognostic performance of Child-Pugh (CTP), Model for End-Stage Liver Disease-Na (MELD-Na), platelet count-to-spleen diameter ratio (PC/SD), and neutrophil-to-lymphocyte ratio (NLR) in predicting 6-week mortality and early rebleeding after AGEVB.

Methods

This retrospective single-center cohort study included 150 cirrhotic patients admitted with acute GEVB. Baseline laboratory and clinical parameters were used to calculate CTP, MELD-Na, PC/SD, and NLR. Predictive accuracy for mortality and rebleeding was evaluated using receiver operating characteristic analysis and penalized multivariable logistic regression.

Results

Six-week mortality occurred in 11.3% and early rebleeding in 20.0% of patients. CTP and MELD-Na scores were significantly higher among non-survivors and patients with rebleeding. The CTP score demonstrated the highest discriminative performance for both outcomes. NLR and PC/SD showed limited predictive value and were not independent predictors after adjustment.

Conclusions

Scores reflecting hepatic functional reserve, particularly the Child-Pugh score, provide superior prognostic accuracy compared with inflammatory and portal hypertension markers in AGEVB.