Objective：To predict the risk of initial esophageal variceal bleeding in patients with liver cirrhosis accompanied by esophageal varices. Methods：Clinical data of patients diagnosed with liver cirrhosis accompanied by esophageal varices at the First Affiliated Hospital of Nanjing Medical University from January 2016 to March 2019 were retrospectively analyzed. Univariate and multivariate Cox regression analyses were used to determine the independent prognostic factors for the occurrence of initial esophageal variceal bleeding in patients with liver cirrhosis and esophageal varices. R software was used to construct the nomogram model. Receiver operating characteristic（ROC）curve was used to assess the prediction ability of the nomogram model. Bootstrap method was used for in-model validation and concordance index（C-index）was calculated to evaluate the discrimination of the model. Calibration curve was plotted to assess the calibration of the model. Results：The maximum diameter of esophageal varices，spleen longitudinal diameter，and total bilirubin（TBIL）were independent risk factors for the occurrence of initial esophageal variceal bleeding in patients with liver cirrhosis and esophageal varices. Based on this，a nomogram prediction model was constructed，with an area under the ROC curve（AUC）of 0.918 for no initial bleeding within 1 year and an AUC of 0.893 for no initial bleeding within 2 years. After internal verification，the C-index of the model was 0.852. The calibration curve shows good consistency between the nomogram prediction results and actual results. Conclusion：The maximum diameter of esophageal varices and TBIL have good predictive value of the occurrence of initial variceal bleeding in patients with liver cirrhosis and esophageal varices. The prediction model based on the three indicators of the maximum diameter of esophageal varices，spleen longitudinal diameter，and TBIL has good discrimination and accuracy.