Navadurong H, Thanapirom K, Wejnaruemarn S, Prasoppokakorn T, Chaiteerakij R, Komolmit P, Treeprasertsuk S. Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis. World J Gastroenterol 2023; 29(32): 4873-4882 [PMID: 37701131 DOI: 10.3748/wjg.v29.i32.4873]
Corresponding Author of This Article
Sombat Treeprasertsuk, MD, PhD, Professor, Division of Gastro-enterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan District, Bangkok 10330, Thailand. battan5410@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Huttakan Navadurong, Kessarin Thanapirom, Salisa Wejnaruemarn, Thaninee Prasoppokakorn, Roongruedee Chaiteerakij, Piyawat Komolmit, Sombat Treeprasertsuk, Division of Gastro-enterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Thaninee Prasoppokakorn, Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi 20110, Thailand
Author contributions: Navadurong H and Treeprasertsuk S designed the research, analyzed the data, and wrote the manuscript; Thanapirom K, Wejnaruemarn S, Prasoppokakorn T, Chaiteerakij R, and Komolmit P administered support; Navadurong H, Thanapirom K, Wejnaruemarn S, and Treeprasertsuk S provided the study materials; Navadurong H and Wejnaruemarn S collected and assembly the data.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No. 423/64).
Informed consent statement: The informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sombat Treeprasertsuk, MD, PhD, Professor, Division of Gastro-enterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan District, Bangkok 10330, Thailand. battan5410@gmail.com
Received: May 21, 2023 Peer-review started: May 21, 2023 First decision: July 10, 2023 Revised: July 20, 2023 Accepted: August 9, 2023 Article in press: August 9, 2023 Published online: August 28, 2023 Processing time: 95 Days and 21.7 Hours
Abstract
BACKGROUND
The albumin-bilirubin (ALBI) score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma (HCC). It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.
AIM
To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.
METHODS
One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020. A total of 113 patients (91.9%) had Child A cirrhosis with a median model for end-stage liver disease (MELD) score of less than 9. Baseline clinical and laboratory variables and decompensation events were collected. The ALBI score was calculated and validated to classify decompensation risk into low-, middle-, and high-risk groups using three ALBI grade ranges (ALBI grade 1: ≤ -2.60; grade 2: > -2.60 but ≤ -1.39; grade 3: > -1.39). Decompensation events were defined as ascites development, variceal bleeding, or grade 3 or 4 hepatic encephalopathy.
RESULTS
Among 123 cirrhotic patients enrolled, 13.8% (n = 17) developed decompensating events at a median time of 25 [95% confidence interval (CI): 17-31] mo. Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events [-2.768 (-2.956 to -2.453) vs -2.007 (-2.533 to -1.537); P = 0.01]. Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve (tAUC) of 0.86 (95%CI: 0.78-0.92), which was significantly better than that of ALBI-Fibrosis-4 (ALBI-FIB4) score (tAUC = 0.77), MELD score (tAUC = 0.66), Child-Pugh score (tAUC = 0.65), and FIB-4 score (tAUC = 0.48) (P < 0.05 for all). The 3-year cumulative incidence of decompensation was 3.1%, 22.6%, and 50% in the low-, middle-, and high-risk groups, respectively (P < 0.001). The odds ratio for decompensation in patients of the high-risk group was 23.33 (95%CI: 3.88-140.12, P = 0.001).
CONCLUSION
The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis. Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.
Core Tip: The albumin-bilirubin (ALBI) score has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies. This study demonstrated that the ALBI score can accurately identify decompensation risk at the 3-year follow-up in patients with compensated cirrhosis. The ALBI score is a simple and ready-to-use tool to help clinicians monitor and make appropriate treatment strategies in patients with compensated cirrhosis.
