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Background Frailty is a known contributor to poor outcomes in acute illness. The Eastern Cooperative Oncology Group (ECOG) performance status has been proposed as a practical measure of patient frailty. This study aimed to determine the independent predictive value of ECOG in the setting of upper gastrointestinal bleeding (UGIB).Methods We conducted a retrospective cohort analysis of 1,003 patients who presented with suspected UGIB at a UK tertiary centre and underwent inpatient oesophagogastroduodenoscopy (OGD) between January 2025 and August 2023. The relationship between inpatient mortality and ECOG score was assessed using multivariate logistic regression. The model was adjusted for Glasgow Blatchford Score (GBS), estimated glomerular filtration rate (eGFR), and cancer status variables.Results With a p-value< 0.001, ECOG performance status was proven to be a significant independent predictor of inpatient mortality (aOR 1.529 CI: 1.285–1.820). As expected, other significant predictors for inpatient mortality were GBS and metastatic cancer. Renal function was not statistically significant.Conclusion The ECOG score is a major predictive factor for inpatient mortality, suggesting the importance of frailty assessment in acute UGIB presentations. Standardising the documentation of ECOG may aid in risk stratification and early care escalation decisions.