Abstract Background Acute variceal bleeding (AVB) continues to carry considerable mortality despite therapeutic advances. Simple, objective prognostic tools are needed for early risk stratification. We evaluated the prognostic performance of the Platelet–Albumin–Bilirubin (PALBI) score compared with the Albumin–Bilirubin (ALBI), Model for End-Stage Liver Disease (MELD), and AIMS65 scores for predicting 5-day, 6-week, and 90-day mortality in cirrhotic patients with AVB. Methods This single-center observational cohort study included consecutive adults with cirrhosis admitted for esophageal variceal AVB at Cho Ray Hospital, Vietnam (October 2021–October 2022). PALBI, ALBI, MELD, and AIMS65 scores were calculated at admission. Primary outcomes were all-cause mortality at 5 days, 6 weeks, and 90 days. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Multivariable logistic regression evaluated independent associations between PALBI and mortality. Results Of 232 patients (mean age 55.0 ± 11.2 years; 78.9% male), 44.4% had alcohol-related cirrhosis and 78.0% were Child–Pugh class B or C. Mortality rates were 3.4% at 5 days, 12.9% at 6 weeks, and 18.9% at 90 days. For 5-day mortality, ALBI (AUC 0.926) performed modestly better than PALBI (AUC 0.902; p = 0.025), though both were excellent. At 6 weeks, PALBI (AUC 0.840) and ALBI (AUC 0.842) performed similarly ( p = 0.929), both significantly outperforming MELD and AIMS65 ( p < 0.01). A PALBI cut-off of − 1.42 identified 5-day survivors with 100% sensitivity and negative predictive value. PALBI remained an independent predictor of 6-week and 90-day mortality in multivariable models. Conclusion PALBI and ALBI provide superior discrimination for early and mid-term mortality following AVB compared to MELD and AIMS65. Specifically, a PALBI cut-off of − 1.42 reliably rules out 5-day mortality, and cut-offs around − 1.6 identify lower-risk patients at 6 weeks and 90 days, supporting the score's utility for practical risk stratification.
Pham et al. (Mon,) studied this question.