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.