Search Results (179)

Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) remains a major clinical emergency, particularly among patients receiving antiplatelet or anticoagulant therapy, whose use has increased substantially in recent years. This study aimed to evaluate the clinical characteristics, endoscopic findings, risk stratification, and outcomes of NVUGIB in patients receiving antithrombotic therapy, and to compare the predictive performance of commonly used prognostic scores. Methods: This prospective cohort study included 89 patients receiving antithrombotic therapy who presented with NVUGIB at Beni-Suef University Hospitals between March 2023 and March 2025. Clinical presentation, laboratory findings, and endoscopic characteristics were recorded. Risk stratification was assessed using Glasgow–Blatchford (GBS), Rockall, Baylor, AIMS65, ABC, and PNED scores. The optimal cut-off values for prediction of rebleeding and mortality were determined using receiver operating characteristic (ROC) analysis and the Youden index. Area under the curve (AUC) values were reported with 95% confidence intervals. Results: Endoscopy revealed that peptic ulcers were the most common lesion (41/89, 46%), followed by erosive disease (27/89, 30%), with the stomach being the most frequently involved site (76.5%). Rebleeding occurred in 16 patients (18.0%), while mortality was observed in 2 patients (2.2%). The Glasgow–Blatchford score demonstrated the most consistent performance for predicting rebleeding, with an optimal cutoff value of 5.5 (derived using the Youden index), yielding 92.9% sensitivity and 78.8% specificity. For mortality prediction, AIMS65, ABC, and PNED scores showed very high AUC values, although these findings should be interpreted cautiously due to the small number of mortality events (n = 2). No statistically significant difference in rebleeding or mortality was observed between single and dual antithrombotic therapy, although patients receiving dual therapy required longer hospitalization and more transfusion units. Conclusions: In patients with antithrombotic-related GI bleeding, ulcers and erosions predominate, with minimal differences between single and dual therapy outcomes. Concomitant NSAID use trends toward higher mortality. Glasgow–Blatchford score offers optimal performance for both rebleeding and mortality prediction, with a cutoff of 5.5 providing excellent sensitivity (92.9%) and specificity (78.8%) for rebleeding risk assessment. Full article

Ciliopathies, initially known as fibrocystic liver diseases, encompass a group of inherited disorders characterized by cystic dilatation of intrahepatic bile ducts and portal fibrosis, frequently associated with renal anomalies. These disorders are now recognized as resulting from defects in primary cilia. The hepatic manifestations, such as congenital hepatic fibrosis (CHF), Caroli syndrome, and polycystic liver disease, arise from ductal plate malformation. Recent studies have implicated variants in the TULP3 (Tubby related protein variant 3) gene in a novel monogenic ciliopathy affecting the liver, kidneys, and heart. We report an 8-year-old boy who presented with variceal bleeding and evolved to a progressive phenotype of CHF. Whole exome sequencing revealed a homozygous novel TULP3 mutation. The patient was managed by endotherapy and propranolol prophylaxis. Due to repeated episodes of variceal bleeding and progressive worsening of hepatic synthetic functions, he underwent a living donor liver transplantation at the age of 12 years. Full article

Background: Pregnancy in women with liver cirrhosis is considered a rare clinical condition due to the decreased fertility commonly associated with chronic liver disease. Hormonal disturbances, anovulation and impaired hepatic function contribute to the lower conception rates observed in this population. However, when pregnancy occurs, it is associated with a significantly increased risk of maternal and fetal complications. Maternal risks include hepatic decompensation, variceal bleeding, ascites, coagulopathy and a higher rate of hypertensive disorders during pregnancy and related complications. Fetal complications involve prematurity, intrauterine growth restriction, and increased perinatal mortality. Methods: We present the clinical case of a woman with idiopathic liver cirrhosis who experienced four consecutive pregnancies with different clinical courses and outcomes. Results: The case highlights the complexity of managing pregnancy in patients with chronic liver disease and underscores the importance of individualized clinical assessment and multidisciplinary management. This report also reviews current management strategies and discusses key considerations for optimizing care in pregnant women with liver cirrhosis. Conclusions: Advances in multidisciplinary care and improved management strategies have contributed to better pregnancy outcomes in recent years. Careful monitoring during pregnancy, appropriate management of portal hypertension, and coordinated care between obstetricians, hepatologists, and neonatologists are essential to minimizing potential complications, ensuring favorable maternal and fetal outcomes. Full article

Objective: To identify independent clinical predictors of acute variceal bleeding (AVB) in cirrhotic patients and to develop a rapid, non-invasive scoring system to facilitate objective risk stratification and resource prioritization in emergency departments (EDs). Methods: This retrospective study focused on the development of a scoring system based on the international normalized ratio of prothrombin time (PT INR) and end-stage renal disease (ESRD) hemodialysis (HD) status to aid in predicting acute variceal bleeding. Results: In our study involving 319 patients, we report an association between a prolonged PT INR (OR 1.73, 95% CI 1.03–2.91; p = 0.038) and the absence of ESRD (p < 0.001) and an increased risk of variceal bleeding. The resulting risk-scoring system, while preliminary, ranges from 2 to 14 points and shows promise, with an AUC of 0.89 suggesting its utility in emergency departments. Conclusions: This scoring system, although in its early stages, may be a beneficial tool in emergency care for patients with cirrhosis. Its practicality and potential efficiency could aid in better patient management. However, broader validation in diverse clinical settings is essential to confirm its applicability and effectiveness. Full article

The transjugular intrahepatic portosystemic shunt (TIPS) is a cornerstone intervention for complications of portal hypertension, including variceal bleeding and refractory ascites. As the population with cirrhosis ages, clinicians increasingly face the question of whether and how to perform TIPS safely in older adults. We reviewed observational cohorts, registry analyses, and systematic reviews/meta-analyses. Existing evidence does not support chronological age as an absolute contraindication; however, multiple studies suggest that advanced age is associated with higher rates of post-TIPS hepatic encephalopathy (HE), early mortality, and readmissions. These findings underscore the need to shift from a binary “eligible vs. ineligible” paradigm to a structured, actionable framework that addresses modifiable risks and anticipates age-related vulnerabilities. Recent clinical practice guidance emphasizes comprehensive pre-TIPS assessment and vigilant post-procedure care, with specific attention to HE risk factors (e.g., prior HE, hyponatremia, renal dysfunction, sarcopenia) and cardiopulmonary reserve. In this narrative review, we propose an elderly-focused clinical pathway built around a four-domain assessment (Liver–Brain–Body–Heart/Kidney) and a traffic-light risk tiering system to guide patient selection, procedural strategy, follow-up scheduling, and triggered management of HE, cardiac decompensation, and renal dysfunction. This pathway aims to preserve the benefits of portal decompression while reducing preventable complications and improving outcomes that are meaningful to older patients, including functional status and quality of life. This narrative review emphasizes that outcomes after TIPS in older adults are determined not by chronological age alone but by multidomain physiological reserve. The proposed pathway informs patient selection, procedural planning, and early post-discharge monitoring in older adults. Full article

Background: Early risk assessment in non-variceal upper gastrointestinal bleeding (NVUGIB) is essential for guiding clinical management. The neutrophil percentage-to-albumin ratio (NPAR) has recently been proposed as a marker reflecting both inflammatory response and physiological reserve. This study aimed to evaluate the prognostic value of NPAR for in-hospital mortality and its relationship with established risk scores in patients with NVUGIB. Methods: This retrospective observational study included 94 patients hospitalized with NVUGIB. NPAR was calculated using laboratory parameters obtained at admission. Patients were stratified according to AIMS65 (<2 vs. ≥2) and Rockall (<5 vs. ≥5) scores. In addition, inflammation-based indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and associations with clinical outcomes were assessed. Results: The in-hospital mortality rate was 12.8%. NPAR values were significantly higher in patients with AIMS65 ≥ 2 and Rockall ≥ 5 (p < 0.001 for both). NPAR demonstrated good discriminative ability for AIMS65 ≥ 2 (AUC: 0.843) and moderate performance for Rockall ≥ 5 (AUC: 0.714). For mortality prediction, NPAR showed excellent performance (AUC: 0.900). A cut-off value of 27.4 yielded a sensitivity of 91.7% and a specificity of 75.6%. Higher NPAR values were associated with increased mortality risk (OR 31.9, 95% CI: 3.88–102.59, p < 0.001), while the negative predictive value was high (98.4%). In contrast, NLR, PLR, and SII showed limited predictive value for in-hospital mortality. Conclusions: NPAR shows promise as a potential prognostic biomarker for assessing disease severity and in-hospital mortality in NVUGIB. Its high negative predictive value and association with established risk scores suggest that it may complement current risk stratification approaches. However, these findings should be considered preliminary, given the retrospective design and limited sample size, and require validation in larger prospective studies. Full article

Background. Autoimmune sclerosing cholangitis (ASC) is a rare clinical entity characterized by overlapping features of autoimmune hepatitis and primary sclerosing cholangitis. It predominantly affects pediatric patients. Therapeutic management is often complex, requiring a multidisciplinary and individualized approach, especially in the context of associated autoimmune diseases. Case presentation. We present the case of a female patient diagnosed at the age of 10 with ASC, for which immunosuppressive therapy with prednisone, azathioprine (AZA), and ursodeoxycholic acid (UDCA) was initiated, with an initially favorable course. One year later, following a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, the patient experienced reactivation of liver disease and subsequently developed ulcerative pancolitis (UC), for which 5-aminosalicylic acid (5-ASA) therapy was initiated. Due to repeated hepatic flares and/or colitis relapses, therapy was escalated successively to mycophenolate mofetil, tacrolimus, and eventually infliximab (IFX). Despite treatment, the liver disease progressed, culminating in liver cirrhosis. Our patient developed portal hypertension and esophageal varices, with two episodes of upper gastrointestinal bleeding requiring endoscopic band ligation. At the age of 14, the patient developed recurrent episodes of non-infectious ulcerative stomatitis. Biopsy of the lesions revealed non-specific chronic inflammation, unrelated to colitis activity (confirmed microscopic remission of UC). By exclusion, an adverse drug reaction was suspected, with AZA being the most likely cause. Following its discontinuation, the lesions resolved. Beyond the physiological and therapeutic aspects, the patient displays marked emotional fragility due to prolonged and repeated hospitalizations (18 out of 60 months), which have impacted treatment adherence. Conclusions. This case highlights the complexity of managing pediatric patients with multiple autoimmune diseases. The necessary combination of immunosuppressive therapies may lead to significant adverse effects and further complicate disease progression. Moreover, psychological components play a crucial role in treatment compliance and therapeutic success, emphasizing the need for an integrated approach that includes specialized psychological support. Full article

Porto-sinusoidal vascular disorder (PSVD) is an umbrella term proposed by the Vascular Liver Disease Interest Group (VALDIG) in 2019. It refers to a group of non-cirrhotic vascular liver diseases that cause portal hypertension. These were previously described as idiopathic non-cirrhotic portal hypertension, hepatoportal sclerosis, nodular regenerative hyperplasia, and incomplete septal fibrosis. PSVD is characterized by injury and remodeling of portal venules and sinusoids. Immune dysregulation, prothrombotic states, infections, medications (e.g., oxaliplatin, thiopurines), toxins (e.g., arsenic), and genetic susceptibility often drive this process. Clinically, PSVD ranges from asymptomatic patients with only abnormal liver tests to severe complications of portal hypertension, such as variceal bleeding, ascites, and portal vein thrombosis. Patients typically have preserved liver synthetic function, helping distinguish PSVD from cirrhosis. Diagnosis is based on VALDIG criteria and requires an adequate liver biopsy that shows no cirrhosis. It also requires specific combinations of clinical signs of portal hypertension and characteristic histological lesions, such as obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal fibrosis. Non-invasive tools, including imaging and liver stiffness measurement, are supportive. They often show discordance between marked portal hypertension and low liver stiffness, suggesting a non-cirrhotic cause. Management follows cirrhosis-based portal hypertension guidelines. This includes non-selective beta-blockers, endoscopic variceal ligation, TIPS, anticoagulation in selected patients, and liver transplantation for refractory or end-stage disease. Prognosis is generally better than in cirrhosis, with a 5-year transplant-free survival rate of approximately 85% compared to 60% in matched cirrhotics. However, major gaps remain in the true epidemiology, the natural history of early or subclinical PSVD, validated non-invasive biomarkers, and disease-modifying therapies. Full article

Background/Objectives: The study aimed to determine the demographic and clinical characteristics of patients with acute variceal bleeding and identify predictive factors associated with treatment outcomes. Methods: The retrospective study included 91 adults hospitalised for oesophageal and/or gastric variceal bleeding at the Department of Gastroenterology, University Hospital of Split. Data were collected on patients’ demographics, clinical characteristics and laboratory findings, as well as treatment outcomes, including length of hospital stay, need for repeat endoscopy, rebleeding, infection incidence, and six-week mortality. Results: Of the 91 patients included, 85.7% were male, and the mean age was 61 ± 9 years. Liver cirrhosis was present in 94.5% of patients, with alcoholic aetiology in 76.7% of cases. The median MELD-Na score was 15 (IQR 11–21), and more than 40% of patients were classified as Child–Pugh B. The median length of hospital stay was 8 days (IQR 5–10.5). Diagnostic EGD was performed in 94.5% of patients, with 80.2% undergoing the procedure within 12 h of admission. Vasoactive therapy was administered to 65.9% of patients, while antibiotic prophylaxis was given in 82.4%. In-hospital mortality was 16.5%, and the cumulative six-week mortality was 25.3%. The severity of liver disease (expressed by MELD-Na and Child–Pugh scores) was associated with a higher risk of in-hospital mortality (p = 0.0045 and p = 0.009, respectively). Early endoscopic intervention did not result in a statistically significant reduction in in-hospital mortality (8.7% vs. 23.5%; p = 0.104). The use of antibiotic prophylaxis, vasoactive drugs, and endoscopic ligation was not associated with lower rates of infections, repeated endoscopies, or mortality. Conclusions: There was a positive correlation between the severity of decompensated liver cirrhosis and in-hospital mortality. Early endoscopic intervention (within 12 h of admission) was not statistically significant in reducing mortality. The use of antibiotic prophylaxis was not associated with reduced mortality or lower incidence of infections. Vasoactive therapy did not significantly reduce the need for repeat endoscopic intervention. Endoscopic ligation did not decrease the likelihood of rebleeding during hospitalisation, in-hospital mortality, or the length of hospital stay. Full article

Background: Early rebleeding after endoscopic variceal ligation (EVL) represents a serious complication in patients with cirrhosis and is associated with poor short-term outcomes. This study aimed to identify independent predictors of early rebleeding after EVL, with a particular focus on distinguishing factors associated with variceal rebleeding from those related to post-banding ulcer (PBU) bleeding, and to assess predictors of six-week mortality. Methods: We conducted a retrospective cohort study including 217 cirrhotic patients who underwent first emergency EVL for an index episode of esophageal variceal bleeding at a tertiary referral center. Early rebleeding was defined as recurrent upper gastrointestinal bleeding occurring between days 6 and 42 after the index EVL. Results: Early rebleeding occurred in 38/217 patients (17.5%): 27/38 (71.1%) variceal rebleeding and 11/38 (28.9%) PBU rebleeding. In multivariable logistic regression analysis, lower hemoglobin (OR = 0.19, 95% CI: 0.067–0.539, p = 0.002) and a higher albumin–bilirubin (ALBI) grade (OR = 24.94, 95% CI: 1.134–548.342, p = 0.041) were independently associated with increased odds of early variceal rebleeding, whereas a higher number of bands applied during index EVL (OR = 0.52, 95% CI: 0.302–0.896, p = 0.019) was independently associated with reduced odds of rebleeding, with excellent model discrimination (area under the curve [AUC] 0.981; 95% CI: 0.959–1.000). For PBU rebleeding, lower fibrinogen level was the only independent predictor (OR = 0.957, 95% CI: 0.916–1.000, p = 0.047), with strong discriminative performance (AUC 0.945; 95% CI: 0.909–0.982). Model for End-Stage Liver Disease (MELD) score, serum albumin, platelet count, and PBU rebleeding independently predicted six-week mortality. Conclusions: Markers of liver function, along with endoscopic parameters, predict early rebleeding after EVL, emphasizing the importance of the complete assessment of cirrhotic patients for refined risk stratification and tailored post-EVL management. Full article

Background and Objectives: Acute variceal bleeding (AVB) in cirrhotic patients remains associated with considerable early rebleeding and mortality despite guideline-based therapy. Endoscopic band ligation (EBL) is recommended as first-line therapy for esophageal variceal bleeding, while alternative endoscopic hemostasis strategies may be required when EBL is technically difficult or judged unsafe. Materials and Methods: We conducted a single, tertiary referral center retrospective cohort study of adults with cirrhosis and AVB undergoing emergency endoscopy. Hemostasis modality at index endoscopy was EBL or argon plasma coagulation (APC), used selectively at the endoscopist’s discretion when bleeding was sourced to gastric varices or when EBL was technically difficult or unsafe. The primary endpoint was 5-day rebleeding, with key secondary endpoints set as 6-week mortality and in-hospital mortality. ICU admission and time to endoscopy were evaluated as process and outcome metrics. Multivariable models were used, adjusted for liver severity (MELD-Na, ALBI, PALBI) and bleeding and mortality scores (AIMS65, Rockall, Glasgow Blatchford). Results: Among 181 eligible AVB cases (APC n = 29, EBL n = 152), 5-day rebleeding was higher with APC (31%) than EBL (13.8%). In-hospital mortality (APC 20.7% vs. EBL 23.0%) and 6-week mortality (APC 31.0% vs. EBL 35.5%) were similar. In adjusted models (age, MELD-Na, time to endoscopy), APC was associated with increased odds of 5-day rebleeding (aOR 2.73, 95% CI 1.06–7.03), but not with in-hospital (aOR 0.51) or 6-week mortality (aOR 0.45). Time to endoscopy was not independently associated with mortality in adjusted models. Discrimination for in-hospital mortality was highest for MELD-Na (AUC 0.898) and ALBI (AUC 0.859). Conclusions: In this observational AVB cohort, APC, used as a rescue or alternative strategy, showed similar short-term mortality compared with EBL after adjustment for liver severity and was associated with higher 5-day rebleeding. APC may be a pragmatic option when EBL is not feasible or is judged unsafe. However, prospective evaluation and careful selection are warranted. Full article

Background/Objectives: Systemic inflammatory markers have recently gained attention as prognostic indicators in various acute conditions. However, their predictive value in non-variceal upper gastrointestinal bleeding (UGIB) remains uncertain. This study aimed to evaluate the prognostic performance of the Systemic Inflammation Response Index (SIRI) and the Aggregate Index of Systemic Inflammation (AISI) for in-hospital mortality among patients with non-variceal UGIB and to compare them with established clinical scoring systems. Methods: This retrospective cohort study included 531 adult patients admitted with non-variceal UGIB between April 2023 and February 2025. Demographic, clinical, and laboratory data were collected at presentation. Inflammatory indices (SIRI, AISI, AISI/Hb) and established risk scores (Glasgow-Blatchford, Rockall, AIMS-65, and ABC) were calculated. The primary outcome was all-cause in-hospital mortality. Discriminatory ability was assessed using receiver operating characteristic (ROC) curve analysis, and independent predictors were identified by multivariable logistic regression. Results: The overall in-hospital mortality rate was 4.7% (25/531). Non-survivors were older and had lower systolic blood pressure, higher serum urea, and elevated inflammatory indices. Among biomarkers, SIRI (AUC = 0.773, 95% CI: 0.737–0.809) and AISI (AUC = 0.709, 95% CI: 0.670–0.747) showed good discriminatory ability, comparable to AIMS-65 (AUC = 0.765) and ABC (AUC = 0.786). In multivariable models, SIRI (OR = 1.10, p = 0.011) and AISI (OR = 1.04 per 100 units, p = 0.003) remained independent predictors of mortality after adjustment for age, systolic blood pressure, hemoglobin, serum urea, and albumin. Conclusions: SIRI and AISI are independent predictors of in-hospital mortality in patients with non-variceal UGIB, demonstrating comparable prognostic performance to conventional risk scores. These readily available inflammatory indices may serve as simple and cost-effective adjuncts for early risk stratification in clinical practice. Full article

Background: Acute gastrointestinal bleeding (GIB) remains a major clinical emergency with substantial morbidity, mortality, and healthcare burden. We aimed to provide a comprehensive characterization of all GIB subtypes, including iatrogenic bleeding, which is underrepresented in previous studies. Methods: In this ambidirectional cohort study, 1021 consecutive adults with overt GIB were enrolled from two Hungarian tertiary centers. Standardized data collection included demographics, comorbidities, medication use, bleeding source, and in-hospital outcomes: mortality, rebleeding, intensive care unit (ICU) admission, length of hospitalization (LoH), endoscopic evaluation and haemostatic intervention, red blood cell transfusion, and surgical intervention. Group comparisons were performed using appropriate statistical tests, and survival was analysed using Kaplan–Meier curves (R v4.4.2; p < 0.05). Results: Non-variceal upper GIB was the most common subtype (51.0%), followed by lower GIB (29.7%), variceal GIB (8.9%), small bowel bleeding (2.3%), and iatrogenic bleeding (7.5%). Overall, in-hospital mortality was 10.6%, highest in variceal bleeding (22%). Rebleeding occurred in 5.3% of cases, most frequently in variceal bleeding. ICU admission was required in 8.9% of patients, again, most common in variceal bleeding (21.6%). The median LoH was 7 days (IQR 4–10), significantly shorter in cases of intraprocedural iatrogenic bleeding. Endoscopy was performed in 91% of cases, with haemostatic intervention in 57%. Surgery was required in 3.4% of patients. Conclusions: Gastrointestinal bleeding represents a heterogeneous clinical entity with distinct outcome profiles across subtypes. Variceal bleeding was associated with the most unfavorable outcomes, whereas intraprocedural iatrogenic bleeding had a favorable course. These findings support subtype-specific clinical management and warrant validation in larger multicenter cohorts. Full article

Background. Somatostatin and its synthetic analog octreotide are suppressive hormones that have been used in the treatment of variceal bleeding or bleeding from portal hypertensive gastropathy. They are also used in the treatment of some cancers, including hepatocellular carcinoma (HCC). Experimental evidence reported that they have potentially useful effects on liver inflammation and fibrosis, acting on Kupffer cells (KCs) and hepatic stellate cells (HSCs). However, clinical data is missing. Therefore, the effect of somatostatin and octreotide was studied on several fibrosis mediators in patients with compensated cirrhosis. Patients and Methods. Fifty-eight patients with HCV-related compensated cirrhosis treated with either somatostatin or octreotide for bleeding from portal gastropathy were compared with twenty-nine healthy controls matched for age and sex. Serum levels of three metalloproteases (MMP1, MMP2 and MMP9) and their inhibitors, TIMP1 and TIMP2, were measured. Additional fibrosis and inflammation mediators—such as nitric oxide (NO), TNFα, soluble ICAM-1, and the CC chemokines RANTES (CCL5) and MIP1a (CCL3)—were also measured. Results. Serum levels of MMP1, MMP2, MMP9 and TIMP1 were significantly decreased in cirrhosis (p < 0.01). TIMP2 levels were increased (p < 0.01). RANTES levels were also significantly decreased (p < 0.01), but NO, TNFα, MIP1a and sICAM-1 were significantly increased (p < 0.01). Administration of somatostatin had no effect on MMP2 or MMP9 but significantly decreased all other mediators. Octreotide had similar but milder effects, but it had no effects on MIP1a and sICAM-1 were demonstrated. Conclusions. Somatostatin and octreotide modulate factors implicated in the progression of fibrosis in the short term. Whether they could be used in the long term as treatment for liver diseases with progressive fibrosis or in cases with intense inflammatory reactions, such as alcoholic hepatitis, requires further investigation. Full article

Background/Objectives: Gastrointestinal bleeding (GIB) in hemodialysis (HD) patients carries substantial mortality risk. The A4C and CHAMPS scores are novel risk stratification tools, while CAGIB was developed for cirrhosis-associated GIB. We compared the discriminative performance of these scores in HD patients with acute GIB, stratified by variceal and non-variceal etiology. Methods: We conducted a retrospective cohort study of 57 HD patients with acute GIB (January 2020–December 2024) following STROBE and TRIPOD guidelines. Patients were stratified as non-variceal (n = 42) or variceal (n = 15). The primary outcome was 30-day mortality; secondary outcomes included ICU admission, rebleeding, and transfusion requirements. A4C, CHAMPS, CAGIB, ABC, AIMS65, and Glasgow–Blatchford scores were compared using AUROC analysis. Results: Mean age was 45.8 ± 13.2 years. Non-variceal GIB (73.7%) was predominantly caused by angiodysplasia (28.6%) and peptic ulcer disease (23.8%); variceal GIB (26.3%) was mainly from esophageal varices (80.0%). Overall 30-day mortality was 17.5%, significantly higher in variceal (26.7%) versus non-variceal GIB (14.3%, p = 0.048). For non-variceal GIB, CHAMPS demonstrated excellent mortality discrimination (AUROC 0.91), significantly outperforming CAGIB (AUROC 0.68, p = 0.02). Conversely, for variceal GIB, CAGIB showed superior performance (AUROC 0.89) compared to CHAMPS (AUROC 0.72, p = 0.04). A4C performed consistently for transfusion prediction across both groups (AUROC 0.75–0.78). Conclusions: Optimal risk stratification in HD patients with GIB requires etiology-specific scoring: CHAMPS for non-variceal and CAGIB for variceal bleeding. This complementary performance reflects distinct pathophysiological mechanisms underlying mortality. Prospective validation in larger multicenter cohorts is warranted. Full article