Acute variceal bleeding is one of the most fatal complications of cirrhosis. Accurate risk stratification is crucial to guide management and predict prognosis. Most existing scoring systems have limitations due to subjective variables and difficulties in practical application. The aim of this study was to evaluate the prognostic performance of the MAP(ASH) score, a novel and bedside applicable system previously validated in nonvariceal upper gastrointestinal bleeding, in patients with acute variceal bleeding.

Between January 2019 and December 2024, 681 patients admitted with suspected upper gastrointestinal bleeding were retrospectively screened. Active variceal bleeding was confirmed in 162 patients, of whom 66 with complete data were included. The MAP(ASH) score was calculated by assigning 2 points for hemoglobin <10 g/dL, systolic blood pressure <90 mmHg, and albumin <2.5 g/dL, and 1 point each for Glasgow Coma Scale <15, ASA score ≥2, and pulse >100/min (range 0–9). Demographics, endoscopic findings, variceal characteristics, MELD-Na, CTP, and MAP(ASH) scores were recorded. Outcomes included in hospital and 6 week mortality and rebleeding.

Of the patients, 60% were male with a mean age of 63 years. The most common etiology of cirrhosis was steatotic liver disease (43.9%), followed by hepatitis B (27.3%). Endoscopic band ligation was performed in 93%. Patients who died or rebled during hospitalization or within 6 weeks had significantly higher MAP(ASH), CTP, and MELD-Na scores. A MAP(ASH) score ≥3.5 predicted in hospital and 6 week mortality as well as rebleeding with sensitivity and specificity exceeding 70%.

MAP(ASH) is a simple and practical scoring system that does not rely on subjective parameters and can be easily applied at the bedside. Our findings suggest that it performs comparably to established prognostic models in cirrhosis. Validation in larger cohorts may further support its use in routine clinical practice.