Admission Prognostic Scores and Endoscopic Findings in Relation to the Two Components of Five-Day Treatment Failure in Acute Variceal Bleeding: An Exploratory Single-Centre Retrospective Cohort Study

Background/Objectives: Five-day treatment failure after acute variceal bleeding combines failure of bleeding control and early rebleeding, which may reflect different clinical processes. We explored whether admission scores and endoscopic findings relate similarly to these components. Methods: All 303 consecutive admissions treated with band ligation at a tertiary centre during 2021–2025 were analysed. Six scores were compared using paired AUROCs and Holm adjustment. Results: Failure occurred in 31 admissions (10.2%): 15 failures of primary haemostasis and 17 rebleeds, with one admission meeting both components. Point estimates of discrimination were higher for rebleeding for all six scores (differences 0.123–0.236), but intervals were wide, and no formal between-component test was performed. No comparison among the six scores using the primary score definitions survived the Holm adjustment for the composite or either component; this does not establish equivalence. Active bleeding at endoscopy was associated with failure of primary haemostasis (odds ratio 4.52, 95% CI 1.40–14.53), whereas its association with rebleeding was uncertain (1.07, 0.40–2.90). Red wale markings showed no clear association. Conclusions: This exploratory pattern suggests that the components may capture different clinical processes, a hypothesis requiring prospective confirmation in a larger cohort. Non-standardised outcome classification, uncertain follow-up after transfer, intervening TIPS and sensitivity to recorded versus recomputed scores limit inference.