Predictive value 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. We follow up the participants to determine their outcome (mortality rate after variceal bleeding and good prognosis) for one year. All participants were subjected to: Complete history, clinical examination, laboratory investigation (Complete blood count, liver and renal function tests, C-reactive protein (CRP) and ascitic fluid study), pelvi-abdominal ultrasound and upper gastrointestinal endoscopy were done. Predicting outcomes and assessment risk of mortality were performed 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 (patients survive without rebleeding or mortality during the duration of the study). Child-Pugh 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 Among the evaluated scoring systems, the ABC score showed the best predictive performance for predicting 1-year mortality in cirrhotic patients with variceal bleeding while Rockall score and C-watch score had no significant in prediction of mortality. Mortality was best predicted by a combination of elevated ABC score, other laboratory and ultra-sonographic findings.