Evaluating the Prognostic Value of the Meld 3.0 Score in Predicting Mortality in Cirrhosis Patients With Acute Variceal Bleeding

INTRODUCTION: Acute variceal bleeding (AVB) is a severe complication of cirrhosis, with a 6-week mortality rate of up to 15–20%. Early risk prediction is essential for guiding management. MELD 3.0, a refined version of the original MELD score, incorporates additional variables (gender, sodium, albumin, capped creatinine) to improve short-term mortality prediction. This study assessed MELD 3.0’s utility in predicting 6-week mortality in cirrhotic patients with AVB, in comparison with MELD, Glasgow-Blatchford Score (GBS), and AIMS65. METHODS: A prospective cohort of cirrhotic patients with AVB admitted to Cho Ray Hospital (Nov 2023–May 2024) was studied. The primary outcome was 6-week mortality; in-hospital mortality was secondary. The predictive performance of MELD 3.0, MELD, GBS, and AIMS65 was evaluated using AUCROC. RESULTS: Among 212 patients, in-hospital and 6-week mortality rates were 4.7% and 19.8%, respectively. For in-hospital mortality, MELD 3.0 showed the highest AUC (0.88), followed by MELD (0.80), AIMS65 (0.74), and GBS (0.59). For 6-week mortality, MELD 3.0 again outperformed others (AUC: 0.81), vs. MELD (0.75), AIMS65 (0.66), and GBS (0.61) (all p < 0.05). A MELD 3.0 cut-off ≥ 20 predicted >25% 6-week mortality (sensitivity 69.1%, specificity 83.5%). CONCLUSION: MELD 3.0 is a strong predictor of early mortality in cirrhotic patients with AVB. A cut-off ≥ 20 may help identify high-risk patients requiring prompt intensive care.