Predictive and prognostic significance of the Age, blood tests and comorbidities (ABC) score, Cologne-watch (C-watch) score and Rockall score for risk of mortality following variceal bleeding among cirrhotic patients

Background: Acute variceal bleeding is one of the most life-threatening complications of liver cirrhosis. The development of several risk assessment score systems has led to the prediction of outcomes like rebleeding and death. These systems include pre- and post-endoscopy evaluations. Objective: To predict outcome of variceal bleeding in cirrhotic patients and detect risk factor of mortality. Patient and Methods: One hundred cirrhotic patients were admitted to Sohag University Hospital, presenting with upper gastrointestinal variceal bleeding between March 2024 and March 2025. All participants will be subjected to: Complete history, clinical examination, laboratory investigation (Complete blood count, liver and renal function tests, C-reactive protein (CRP) and ascitic fluid study), abdominal ultrasound and upper endoscopy were done. Predicting outcomes and assessment risk of mortality by: ABC score, C-watch score and Rockall score. Results: Mortality occurred in 36% of cases, rebleeding in 8%, while 56% had a good prognosis. Child score C were statistically significant in predicting mortality (P value: 0.01). Diagnostic performance of the studied scores in prediction of mortality showed that ABC score had the highest statistically significant diagnostic ability in predicting mortality, with an AUC of 72.6%, 95% CI: 0.6: 0.8, P value: <0.001. The cutoff point was 9.5 carrying a sensitivity of 44.4% and a specificity of 93.7%. Conclusion: Mortality was best predicted by a combination of elevated ABC score, other laboratory finding as (increased INR, CRP and ascitic fluid infection), the presence of combined portal-vein dilatation with thrombosis, hepatic focal lesion, presence of ascites on ultrasound and Child-Pugh class C. Among the evaluated scoring systems, the ABC score showed the best predictive performance for mortality.