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Comparative Evaluation of A4C, CHAMPS, and CAGIB Scores for Risk Stratification in Hemodialysis Patients with Acute

Mete Ucdal1, Evren Ekingen2

  • 1Department of Internal Medicine, Etimesgut Şehit Sait Ertürk State Hospital, Ankara 06790, Turkey.

Diagnostics (Basel, Switzerland)
|February 13, 2026
PubMed

Insights

Risk stratification for gastrointestinal bleeding (GIB) in hemodialysis (HD) patients requires etiology-specific scores. CHAMPS is best for non-variceal GIB, while CAGIB excels for variceal bleeding, improving mortality prediction.

Area of Science:

  • Nephrology
  • Gastroenterology
  • Clinical Epidemiology

Background:

  • Gastrointestinal bleeding (GIB) poses a significant mortality risk for patients undergoing hemodialysis (HD).
  • Existing risk stratification scores like A4C and CHAMPS are novel, while CAGIB was designed for cirrhosis-associated GIB.
  • Comparing these scores in HD patients with acute GIB, stratified by bleeding source, is crucial for accurate prognostication.

Purpose of the Study:

  • To compare the discriminative performance of A4C, CHAMPS, and CAGIB scores in hemodialysis patients with acute GIB.
  • To evaluate the efficacy of these scores in predicting 30-day mortality, ICU admission, rebleeding, and transfusion needs.
  • To determine the optimal scoring system for risk stratification based on the etiology of GIB (variceal vs. non-variceal).

Main Methods:

  • A retrospective cohort study included 57 hemodialysis patients with acute GIB from January 2020 to December 2024.
  • Patients were stratified into non-variceal (n=42) and variceal (n=15) GIB groups.
  • Performance of A4C, CHAMPS, CAGIB, ABC, AIMS65, and Glasgow-Blatchford scores was assessed using AUROC analysis for 30-day mortality and other outcomes.

Main Results:

  • Overall 30-day mortality was 17.5%, higher in variceal (26.7%) than non-variceal GIB (14.3%).
  • For non-variceal GIB, CHAMPS showed superior mortality discrimination (AUROC 0.91) over CAGIB (AUROC 0.68).
  • For variceal GIB, CAGIB demonstrated better performance (AUROC 0.89) compared to CHAMPS (AUROC 0.72). A4C showed consistent transfusion prediction (AUROC 0.75-0.78).

Conclusions:

  • Optimal risk stratification for GIB in hemodialysis patients necessitates etiology-specific scoring tools.
  • CHAMPS is recommended for non-variceal GIB, while CAGIB is preferred for variceal bleeding.
  • Prospective validation in larger, multicenter cohorts is warranted to confirm these findings.

Keywords:
A4C scoreCAGIB scoreCHAMPS scorecirrhosisgastrointestinal bleedinghemodialysismortalityrisk stratificationvariceal bleeding

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