Upper GI Bleed (Variceal)

Acute variceal hemorrhage (AVH) is a life-threatening complication of portal hypertension, most commonly from esophageal or gastric varices in cirrhotic patients. Even with modern therapy, 6-week mortality remains 10–20%, with most deaths occurring in Child-Pugh class C patients. [1-2] The following is a structured clinical summary for emergency medicine and primary care management.

The following algorithm outlines the management pathway for acute GI bleeding in cirrhotic patients:

1. History

• Hematemesis (bright red blood or coffee-ground emesis) — red blood emesis is the most common presentation of variceal bleeding (67%), while melena predominates in peptic ulcer bleeding [4-5]
• Volume and frequency of hematemesis, presence of melena or hematochezia
• Timing of onset, rapidity of progression, preceding symptoms (lightheadedness, syncope, presyncope)
• Prior episodes of GI bleeding or known varices
• Known liver disease, cirrhosis etiology (alcohol, viral hepatitis, NAFLD, autoimmune)
• Recent alcohol use, NSAID/aspirin use, anticoagulant use
• Symptoms of hepatic encephalopathy (confusion, somnolence)
• Important negatives: abdominal pain (less typical in variceal bleed vs. peptic ulcer), dysphagia, weight loss

2. Alarm Features

• Hemodynamic instability: tachycardia, hypotension, orthostasis — common in AVH [6]
• Massive hematemesis with bright red blood
• Altered mental status (encephalopathy vs. hypovolemic shock)
• Signs of aspiration (cough, desaturation during active emesis)
• Refractory bleeding despite initial resuscitation
• Features of decompensated cirrhosis: new or worsening ascites, jaundice, encephalopathy
• Myocardial injury occurs in ~36% of cirrhotic patients with variceal bleeding and is independently associated with higher 6-week mortality (21% vs. 7%) [7]

3. Medications

Acute treatment:

• Octreotide: 50 mcg IV bolus → 25–50 mcg/hr infusion for 2–5 days (most commonly used vasoactive agent in the US) [1][8]
• Terlipressin: 2 mg IV q4–6h for 24–48h, then 1 mg IV q4–6h (not approved for this indication in North America) [1]
• Ceftriaxone: 1 g IV q24h for up to 5 days — prophylactic antibiotics reduce short-term mortality (18.5% vs. 22.2% with placebo) [1][9]
• Erythromycin: 125–250 mg IV given 30–120 min before endoscopy as a prokinetic to improve visualization [1]
• PPI: may be started empirically if non-variceal source cannot be excluded [10]

Prophylaxis (secondary prevention):

• Carvedilol (preferred, 12.5 mg daily) or propranolol — initiate at discontinuation of vasoactive therapy [1][9]
• Combination NSBB + EVL is standard for secondary prophylaxis [11]

Contraindicated/caution:

• NSAIDs — increase bleeding risk
• Avoid liberal FFP/platelet transfusion — worsens portal pressure without proven benefit [1]
• Vasopressin — associated with ventricular arrhythmias and sudden death in cirrhotic patients [12]
• Caution with ACE inhibitors/ARBs in cirrhosis [13]

4. Diet

• NPO initially during acute bleed and pending endoscopy
• Early feeding within 72 hours post-endoscopy is recommended [14]
• Sodium restriction (<2 g/day) for patients with ascites [9]
• Adequate protein and calorie intake is critical — malnutrition is common in cirrhosis; nutritionist involvement recommended [9]
• Alcohol abstinence is essential regardless of cirrhosis etiology [9]

5. Review of Systems

• GI: hematemesis, melena, hematochezia, abdominal distension, nausea/vomiting
• Neuro: confusion, asterixis, somnolence (hepatic encephalopathy)
• Cardiopulmonary: dyspnea, chest pain, orthopnea (cirrhotic cardiomyopathy, hepatopulmonary syndrome)
• Renal: decreased urine output (hepatorenal syndrome)
• Constitutional: fatigue, weight loss, anorexia, muscle cramps (64% prevalence in cirrhosis), pruritus (39%) [9]

6. Collateral History and Family History

• Alcohol use history (quantity, duration, last drink) — most important collateral
• Prior liver disease diagnosis, prior endoscopy findings, prior TIPS placement
• Medication compliance (beta-blockers, lactulose)
• Family history of liver disease (hemochromatosis, Wilson disease, alpha-1-antitrypsin deficiency)
• Social context: housing stability, caregiver availability, ability to follow up

7. Risk Factors

• Cirrhosis of any etiology (alcohol, viral hepatitis B/C, NAFLD, autoimmune) [1]
• Child-Pugh class B or C — independent predictor of variceal bleeding and mortality [15-16]
• Large variceal size and red wale signs on endoscopy [1]
• HVPG ≥12 mmHg (threshold for variceal bleeding) [1]
• Thrombocytopenia (platelets <110 × 10⁹/L) — associated with CSPH and variceal bleeding risk [9]
• Active alcohol use, non-compliance with beta-blocker prophylaxis
• Hepatocellular carcinoma, portal vein thrombosis
• H. pylori infection (OR 7.36 for variceal bleeding in one study) [15]
• Prior variceal bleeding episode (highest risk factor for rebleeding)

8. Differential Diagnosis

• Esophageal variceal hemorrhage (most common portal hypertensive source, ~70% of UGIB in cirrhosis) [2]
• Gastric variceal hemorrhage — often more massive and harder to control endoscopically [6]
• Peptic ulcer disease — present in ~38% of cirrhotic patients with UGIB; distinguished by melena-predominant presentation [4]
• Portal hypertensive gastropathy — diffuse mucosal oozing
• Mallory-Weiss tear — post-retching, typically self-limited
• Gastric/esophageal malignancy
• Ectopic varices (duodenal, rectal, stomal) — consider if EGD is negative [17]
• Dieulafoy lesion
• Aortoenteric fistula (in patients with prior aortic graft — cannot miss)

9. Past Medical History

• Prior variceal bleeding episodes and treatments (EVL, sclerotherapy, TIPS)
• Cirrhosis etiology and duration, Child-Pugh class, MELD score
• History of ascites, SBP, hepatic encephalopathy, hepatorenal syndrome
• Hepatocellular carcinoma screening status
• Portal vein thrombosis
• Cardiac disease (cirrhotic cardiomyopathy, coronary artery disease — affects transfusion threshold)
• Coagulopathy history

10. Physical Exam

Vital signs:

Stigmata of chronic liver disease (specificity >90% for cirrhosis): [9][18]

• Spider angiomas, palmar erythema, Terry nails
• Jaundice/scleral icterus
• Gynecomastia, testicular atrophy, decreased body hair
• Caput medusae, parotid enlargement (alcohol-related)
• Dupuytren contracture (alcohol use, not cirrhosis per se)

Abdominal exam:

• Ascites (shifting dullness — 83% sensitivity, 56% specificity) [9]
• Splenomegaly (palpable spleen suggests portal hypertension)
• Hepatomegaly (early) vs. shrunken liver (advanced cirrhosis)

Neurologic:

Rectal exam:

11. Lab Studies

• CBC: hemoglobin (transfusion threshold ~7 g/dL), platelet count (thrombocytopenia suggests portal hypertension) [1]
• BMP: creatinine (hepatorenal syndrome, MELD calculation), BUN, electrolytes, sodium (hyponatremia common)
• LFTs: AST, ALT, bilirubin, albumin (Child-Pugh and MELD components)
• Coagulation: PT/INR — note that INR does not reliably predict hemostatic dysfunction in cirrhosis [1]
• Type and crossmatch: at least 2–4 units pRBCs
• Lactate: marker of tissue hypoperfusion
• Blood cultures: if infection suspected
• Ammonia: if encephalopathy present
• Fibrinogen: may be low in advanced liver disease
• Do NOT transfuse FFP based on INR targets — no evidence of benefit and potential harm from volume overload and worsening portal pressure [1]

12. Imaging

• Bedside POCUS: assess for ascites, splenomegaly, portal vein diameter (>12 mm suggests portal hypertension), portal vein flow velocity [19-20]
• CT abdomen with contrast (once stable): evaluate for portal vein thrombosis, hepatocellular carcinoma, portosystemic collaterals, vascular anatomy for potential TIPS [1][21]
• Doppler ultrasound: portal vein patency and flow direction (hepatopetal vs. hepatofugal) [17]
• CXR: rule out aspiration pneumonia (most common infection in variceal bleeding admissions) [1]
• Imaging is NOT required before initiating treatment — do not delay resuscitation or vasoactive therapy

13. Special Tests

Scoring systems:

• Child-Pugh Score: best predictor of in-hospital outcome (AUC 0.9); CTP >7 associated with 19.8% vs. 0.9% mortality [22]
• MELD Score: MELD ≥19 predicts ≥20% 6-week mortality; MELD <11 predicts <5% mortality [23]
• Glasgow-Blatchford Score (GBS): useful for initial risk stratification of UGIB; GBS of 0 identifies patients safe for outpatient management (though rarely applicable in variceal bleeding) [22][24]
• AIMS65: excellent discrimination for in-hospital mortality in variceal bleeding (AUC >0.8) [25]

Point-of-care:

• POCUS portal vein assessment — SCoPE score (splenomegaly, coagulopathy, portal vein flow velocity) has AUC 0.843 for predicting variceal etiology [19]
• Fibrosis scores (FIB-4, APRI) can help predict variceal etiology in undifferentiated UGIB [19][26]

Endoscopy:

• EGD within 12 hoursHepatology + 1[1][8]

14. ECG

• QTc prolongation present in ~25% of cirrhotic patients — associated with cirrhotic cardiomyopathy and worsening Child-Pugh class [27]
• Monitor for electrolyte-driven arrhythmias (hypokalemia, hypomagnesemia from diuretics, massive transfusion)
• Ventricular arrhythmias reported with vasopressin use — avoid vasopressin; use octreotide instead [12]
• Obtain ECG to evaluate for demand ischemia/myocardial injury — troponin elevation occurs in ~36% and independently predicts mortality [7]
• Sinus tachycardia is expected with hemorrhage; new arrhythmias warrant further evaluation

15. Assessment

Severity stratification is driven by Child-Pugh class and MELD score: [16][28]

• Child-Pugh A / MELD ≤11: low mortality (2–4%)
• Child-Pugh B / MELD 12–18: intermediate mortality (10–12%)
• Child-Pugh C / MELD ≥19: high mortality (22–46%) — consider early/preemptive TIPS

Typical presentation is acute hematemesis with bright red blood in a patient with known or suspected cirrhosis. Atypical presentations include isolated melena, syncope, or worsening encephalopathy without overt bleeding. Complications include aspiration pneumonia, hepatorenal syndrome, SBP, hepatic encephalopathy, rebleeding (20% in-hospital), and multiorgan failure. [1][4]

16. Treatment Plan

Initial stabilization (ED):

• Airway: intubate only if necessary (massive hematemesis, altered mental status, aspiration risk) — intubation itself increases mortality; extubate as soon as safely possible [1][24]
• Two large-bore IVs, avoid aggressive crystalloid resuscitation (worsens portal pressure)
• Restrictive transfusion: target Hgb ~7 g/dL (8 g/dL if active coronary disease) [1]
• Start octreotide immediately: 50 mcg IV bolus → 25–50 mcg/hr drip [1]
• Start ceftriaxone 1 g IV q24h [1]
• Erythromycin 125–250 mg IV 30–120 min pre-endoscopy [1]

Endoscopic therapy:

• EGD within 12 hours [1]
• Esophageal varices: endoscopic variceal ligation (EVL) — success rate ~89% [1][4]
• Gastric varices: cyanoacrylate glue injection ± coil embolization (success 87–100%); EVL less effective for gastric varices [1]

Refractory bleeding:

• Balloon tamponade (Sengstaken-Blakemore or Minnesota tube) or self-expanding metal stent as bridge to definitive therapy [1][14]
• Preemptive TIPS within 72 hours (ideally 24 hours) for high-risk patients: Child-Pugh B >7 with active bleeding at endoscopy, or Child-Pugh C 10–13 — improved 1-year survival (86% vs. 61%) [1][9]

Post-endoscopy:

• Continue octreotide drip for 2–5 days [1]
• Continue antibiotics for up to 5 days [1]
• Initiate NSBB (carvedilol preferred) at discontinuation of vasoactive therapy [1]
• Repeat EVL every 2–4 weeks until variceal obliteration [1]

The following figure summarizes the endoscopic and post-endoscopic management algorithm:

17. Disposition

Admission criteria (all variceal bleeds require admission):

• ICU admission for hemodynamic instability, active bleeding, need for intubation, or high-risk features (Child-Pugh C, MELD ≥19) [1][8]
• Step-down/monitored bed for stable patients after successful endoscopic hemostasis

Specialist consultation triggers:

• GI/Hepatology: all cases — for urgent endoscopy and ongoing management
• Interventional radiology: for TIPS evaluation in high-risk patients or refractory bleeding [1]
• Surgery: rarely needed; consider if all other modalities fail
• Transplant hepatology: evaluate for liver transplant candidacy during admission

Discharge criteria:

• Hemodynamically stable for ≥24 hours
• No evidence of rebleeding
• Tolerating oral intake
• On appropriate secondary prophylaxis (NSBB ± EVL plan)
• Encephalopathy resolved or at baseline
• Reliable follow-up arranged

18. Follow Up / Return Precautions

Follow-up timing:

• Repeat EVL every 2–4 weeks until variceal obliteration [1]
• Hepatology follow-up within 1–2 weeks of discharge
• Liver transplant evaluation if appropriate
• Variceal screening endoscopy: annually if decompensated, every 2–3 years if compensated [9]

Return precautions — instruct patients to return immediately for:

• Recurrent hematemesis, bloody or black stools
• Lightheadedness, dizziness, or syncope
• Confusion, excessive drowsiness (encephalopathy)
• Fever, abdominal pain, worsening abdominal distension
• Inability to tolerate medications or oral intake

Patient counseling:

• Absolute alcohol abstinence
• Medication adherence (beta-blockers, lactulose if prescribed)
• Avoid NSAIDs
• Expected recovery: rebleeding risk is highest in the first 6 weeks (~15–20% 6-week mortality even with optimal therapy) [1-2]
• Ensure understanding of when to activate EMS

References

1. AASLD Practice Guidance on Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis. — Kaplan DE, Ripoll C, Thiele M, et al. Hepatology. 2024.

2. AASLD Practice Guidance on Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis. — Kaplan DE, Ripoll C, Thiele M, et al. Hepatology. 2024.

3. AASLD Practice Guidance on Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis. — Kaplan DE, Ripoll C, Thiele M, et al. Hepatology. 2024.

4. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. — Garcia-Tsao G, Abraldes JG, Rich NE, Wong VW. Gastroenterology. 2024.

5. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. — Garcia-Tsao G, Abraldes JG, Rich NE, Wong VW. Gastroenterology. 2024.

6. Management of upper gastrointestinal hemorrhage related to portal hypertension. — Patrick S. Kamath, Louis M. Wong Kee Song Yamada's Textbook of Gastroenterology 7e. 2022.

7. Management of upper gastrointestinal hemorrhage related to portal hypertension. — Patrick S. Kamath, Louis M. Wong Kee Song Yamada's Textbook of Gastroenterology 7e. 2022.

8. Characteristics of Peptic Ulcer Bleeding in Cirrhotic Patients With Esophageal and Gastric Varices. — Lu Z, Sun X, Han J, et al. Scientific Reports. 2020.

9. Characteristics of Peptic Ulcer Bleeding in Cirrhotic Patients With Esophageal and Gastric Varices. — Lu Z, Sun X, Han J, et al. Scientific Reports. 2020.

10. Upper Gastrointestinal Bleeding Etiology Score for Predicting Variceal and Non-Variceal Bleeding. — Pongprasobchai S, Nimitvilai S, Chasawat J, Manatsathit S. World Journal of Gastroenterology. 2009.

11. Upper Gastrointestinal Bleeding Etiology Score for Predicting Variceal and Non-Variceal Bleeding. — Pongprasobchai S, Nimitvilai S, Chasawat J, Manatsathit S. World Journal of Gastroenterology. 2009.

12. Gastroesophageal Variceal Hemorrhage. — Sharara AI, Rockey DC. The New England Journal of Medicine. 2001.

13. Gastroesophageal Variceal Hemorrhage. — Sharara AI, Rockey DC. The New England Journal of Medicine. 2001.

14. Myocardial Injury Is a Risk Factor for 6-Week Mortality in Liver Cirrhosis Associated Esophagogastric Variceal Bleeding. — Liu B, Li Q, Ding H, et al. Scientific Reports. 2023.

15. Myocardial Injury Is a Risk Factor for 6-Week Mortality in Liver Cirrhosis Associated Esophagogastric Variceal Bleeding. — Liu B, Li Q, Ding H, et al. Scientific Reports. 2023.

16. The Role of Endoscopy in the Management of Variceal Hemorrhage. — Hwang JH, Shergill AK, Acosta RD, et al. Gastrointestinal Endoscopy. 2014.

17. The Role of Endoscopy in the Management of Variceal Hemorrhage. — Hwang JH, Shergill AK, Acosta RD, et al. Gastrointestinal Endoscopy. 2014.

18. Diagnosis and Management of Cirrhosis and Its Complications: A Review. — Tapper EB, Parikh ND. The Journal of the American Medical Association. 2023.

19. Diagnosis and Management of Cirrhosis and Its Complications: A Review. — Tapper EB, Parikh ND. The Journal of the American Medical Association. 2023.

20. Management of Acute Upper Gastrointestinal Bleeding. — Stanley AJ, Laine L. BMJ. 2019.

21. Management of Acute Upper Gastrointestinal Bleeding. — Stanley AJ, Laine L. BMJ. 2019.

22. Clinical Algorithms for the Prevention of Variceal Bleeding and Rebleeding in Patients With Liver Cirrhosis. — Pfisterer N, Unger LW, Reiberger T. World Journal of Hepatology. 2021.

23. Clinical Algorithms for the Prevention of Variceal Bleeding and Rebleeding in Patients With Liver Cirrhosis. — Pfisterer N, Unger LW, Reiberger T. World Journal of Hepatology. 2021.

24. Cirrhotic Cardiomyopathy. — Zardi EM, Abbate A, Zardi DM, et al. Journal of the American College of Cardiology. 2010.

25. Cirrhotic Cardiomyopathy. — Zardi EM, Abbate A, Zardi DM, et al. Journal of the American College of Cardiology. 2010.

26. Cardiovascular Complications of Cirrhosis. — Møller S, Henriksen JH. Gut. 2008.

27. Cardiovascular Complications of Cirrhosis. — Møller S, Henriksen JH. Gut. 2008.

28. Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management. — Shung DL, Laine L. Alimentary Pharmacology & Therapeutics. 2024.

29. Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management. — Shung DL, Laine L. Alimentary Pharmacology & Therapeutics. 2024.

30. Clinical Characteristics and Predictors of Esophagogastric Variceal Bleeding Among Patients With HCV-induced Liver Cirrhosis: An Observational Comparative Study. — El Sheref SEDM, Afify S, Berengy MS. PloS One. 2022.

31. Clinical Characteristics and Predictors of Esophagogastric Variceal Bleeding Among Patients With HCV-induced Liver Cirrhosis: An Observational Comparative Study. — El Sheref SEDM, Afify S, Berengy MS. PloS One. 2022.

32. Multicenter External Validation of Risk Stratification Criteria for Patients With Variceal Bleeding. — Conejo I, Guardascione MA, Tandon P, et al. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association. 2018.

33. Multicenter External Validation of Risk Stratification Criteria for Patients With Variceal Bleeding. — Conejo I, Guardascione MA, Tandon P, et al. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association. 2018.

34. Diagnosis and Management of Ectopic Varices in Portal Hypertension. — Tranah TH, Nayagam JS, Gregory S, et al. The Lancet. Gastroenterology & Hepatology. 2023.

35. Diagnosis and Management of Ectopic Varices in Portal Hypertension. — Tranah TH, Nayagam JS, Gregory S, et al. The Lancet. Gastroenterology & Hepatology. 2023.

36. Liver Cirrhosis. — Ginès P, Krag A, Abraldes JG, et al. Lancet. 2021.

37. Liver Cirrhosis. — Ginès P, Krag A, Abraldes JG, et al. Lancet. 2021.

38. A Portal Into Hemodynamics: Utility of Portal Vein Ultrasound in Predicting Variceal Etiology of Upper Gastrointestinal Hemorrhage in the Emergency Department. — Naik S, Ravindra P, Chaudhuri S, et al. Internal and Emergency Medicine. 2025.

39. A Portal Into Hemodynamics: Utility of Portal Vein Ultrasound in Predicting Variceal Etiology of Upper Gastrointestinal Hemorrhage in the Emergency Department. — Naik S, Ravindra P, Chaudhuri S, et al. Internal and Emergency Medicine. 2025.

40. AASLD Practice Guideline on Noninvasive Liver Disease Assessment of Portal Hypertension. — Sterling RK, Asrani SK, Levine D, et al. Hepatology. 2025.

41. AASLD Practice Guideline on Noninvasive Liver Disease Assessment of Portal Hypertension. — Sterling RK, Asrani SK, Levine D, et al. Hepatology. 2025.

42. CT Rule-in and Rule-Out Criteria for Clinically Significant Portal Hypertension in Chronic Liver Disease. — Heo S, Lee SS, Choi SH, et al. Radiology. 2023.

43. CT Rule-in and Rule-Out Criteria for Clinically Significant Portal Hypertension in Chronic Liver Disease. — Heo S, Lee SS, Choi SH, et al. Radiology. 2023.

44. Child-Pugh Score, MELD Score and Glasgow Blatchford Score to Predict the in-Hospital Outcome of Portal Hypertensive Patients Presenting With Upper Gastrointestinal Bleeding: An Experience From Tertiary Healthcare System. — Jamil Z, Perveen S, Khalid S, et al. Journal of Clinical Medicine. 2022.

45. Child-Pugh Score, MELD Score and Glasgow Blatchford Score to Predict the in-Hospital Outcome of Portal Hypertensive Patients Presenting With Upper Gastrointestinal Bleeding: An Experience From Tertiary Healthcare System. — Jamil Z, Perveen S, Khalid S, et al. Journal of Clinical Medicine. 2022.

46. A MELD-based Model to Determine Risk of Mortality Among Patients With Acute Variceal Bleeding. — Reverter E, Tandon P, Augustin S, et al. Gastroenterology. 2014.

47. A MELD-based Model to Determine Risk of Mortality Among Patients With Acute Variceal Bleeding. — Reverter E, Tandon P, Augustin S, et al. Gastroenterology. 2014.

48. Emergency Medicine Updates: Upper Gastrointestinal Bleeding. — Long B, Gottlieb M. The American Journal of Emergency Medicine. 2024.

49. Emergency Medicine Updates: Upper Gastrointestinal Bleeding. — Long B, Gottlieb M. The American Journal of Emergency Medicine. 2024.

50. Prognostic Value of Risk Scoring Systems for Cirrhotic Patients With Variceal Bleeding. — Tantai XX, Liu N, Yang LB, et al. World Journal of Gastroenterology. 2019.

51. Prognostic Value of Risk Scoring Systems for Cirrhotic Patients With Variceal Bleeding. — Tantai XX, Liu N, Yang LB, et al. World Journal of Gastroenterology. 2019.

52. Prediction of Esophageal Varices and Variceal Hemorrhage in Patients With Acute Upper Gastrointestinal Bleeding. — Rockey DC, Elliott A, Lyles T. Journal of Investigative Medicine : The Official Publication of the American Federation for Clinical Research. 2016.

53. Prediction of Esophageal Varices and Variceal Hemorrhage in Patients With Acute Upper Gastrointestinal Bleeding. — Rockey DC, Elliott A, Lyles T. Journal of Investigative Medicine : The Official Publication of the American Federation for Clinical Research. 2016.

54. Electrocardiographic characteristics of cirrhotic patients and their association with Child‐Pugh score. — Jahangiri S, Abdiardekani A, Jamshidi S, et al. Clinical Cardiology. 2023.

55. Electrocardiographic characteristics of cirrhotic patients and their association with Child‐Pugh score. — Jahangiri S, Abdiardekani A, Jamshidi S, et al. Clinical Cardiology. 2023.

56. MELD, MELD 3.0, Versus Child Score to Predict Mortality After Acute Variceal Hemorrhage: A Multicenter US Cohort. — Buckholz A, Wong R, Curry MP, et al. Hepatology Communications. 2023.

57. MELD, MELD 3.0, Versus Child Score to Predict Mortality After Acute Variceal Hemorrhage: A Multicenter US Cohort. — Buckholz A, Wong R, Curry MP, et al. Hepatology Communications. 2023.