Objective To compare the value of Liaoning scoring system, model for end-stage liver disease (MELD), model for end-stage liver disease-Na (MELD-Na) and Blatchford score in predicting high-risk esophageal varices (EVs), hemorrhage or re-hemorrhage within 1 year and blood transfusion treatment in cirrhotic patients. Methods Clinical data of 170 patients with esophageal varices confirmed by endoscopy from January 2018 to September 2019 were recorded. Liaoning score, MELD, MELD-Na score and Blatchford score were calculated when the first endoscopy was performed. These patients were followed up, and hemorrhage or re-hemorrhage within 1 year was recorded. Receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the accuracy of 4 scoring systems in predicting high-risk EVs, hemorrhage or re-hemorrhage within 1 year after the first endoscopy and blood transfusion. Cut-off values were obtained, and groups divided by cut-off values were compared for the proportion of high-risk EVs and hemorrhage or re-hemorrhage. Results The cut-off value of high-risk EVs in patients with cirrhosis predicted by Liaoning score was 0.45, and the AUC was 0.702 (95%CI:0.612-0.781, P<0.01), superior to MELD, MELD-Na and Blatchford score (AUC were 0.593, 0.648, 0.610, respectively). The proportion of high-risk EVs in Liaoning score ≥0.45 and <0.45 were 71.8% (89/124) and 34.8% (16/46) with significant differences (χ2=19.442, P<0.01). The AUC of Liaoning score for predicting hemorrhage or re-hemorrhage within 1 year was 0.680 (95%CI: 0.595-0.765, P<0.01), superior to MELD, MELD-Na and Blatchford score (AUC were 0.605,0.615,0.598, respectively). AUC of Blatchford score for predicting blood transfusion was 0.775 (95%CI:0.687-0.863, P<0.01), superior to MELD, MELD-Na and Liaoning score (AUC were 0.653, 0.719, 0.631, respectively). Conclusion Liaoning score can predict high-risk EVs, hemorrhage or re-hemorrhage within 1 year after the first endoscopy in patients with cirrhosis and is superior to MELD, MELD-Na and Blatchford score. Blatchford score can effectively predict whether cirrhosis patients with EVs need blood transfusion.