Gastrointestinal bleeding due to portal hypertension in cirrhosis: Prognostic value of the CAGIB score

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Published Mar 10, 2026
https://doi.org/10.62438/tunismed.v104i01.6058
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Vol. 104 No. 01 (2026): Tunis Med Jan 2026

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Asma Ben Mohamed
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Alaa Mnif
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Manel Yakoubi
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Ghada Gharbi
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Moufida Mahmoudi
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Amal Khsiba
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Mouna Medhioub
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Mohamed Amine Hamzaoui
Departement of gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

Abstract

Introduction:
Upper gastrointestinal bleeding (UGIB) due to portal hypertension (PH) is a severe complication of cirrhosis. No specific score is currently validated to assess prognosis in this setting. We aimed to evaluate the performance of the CAGIB score in predicting recurrence and early mortality following upper gastrointestinal bleedingin in cirrhotic patients.


Methods:
We conducted a retrospective study including cirrhotic patients hospitalized for uppergastrointestinal bleedinginrelatedportal hypertension from 2012 to 2022. The following scores were calculated: CHILD-PUGH, MELD, MELD-Na, MELD 3.0, ALBI, ROCKALL, GBS, NLR, and CAGIB. Their performance in predicting early recurrence (≤5 days), short-term recurrence (≤6 weeks), and early mortality (≤6 weeks) was compared using ROC curves.


Results:
A total of 105 patients were included (mean age 63 years; F/M ratio 1.05). Bleeding originated from oesophageal varices in 94.3% of cases. Endoscopic treatment was performed in 96 patients (endoscopic band ligation in 90 cases). Short-term recurrence occurred in 20%, early recurrence in 3.8%, and early mortality in 13.3%. The CAGIB score was the best predictor of early recurrence (AUC=0.995; sensitivity=83.3%; specificity=99.6%) and early mortality (AUC=0.891; sensitivity=85.7%; specificity=83.5%) at a threshold ≥ -4.648.


Conclusion:
The CAGIB score demonstrated superior prognostic performance for early recurrence and mortality following UGIB due to portal hypertension. It appears to be a reliable and reproducible tool for risk stratification in cirrhotic patients.

Keywords:

Cirrhosis , Prognosis , Portal hypertension , Gastrointestinal bleeding , recurrence-mortality

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