Published online Aug 28, 2023. doi: 10.3748/wjg.v29.i32.4873
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
The albumin-bilirubin (ALBI) score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma (HCC). It has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.
The utility of ALBI score in predicting decompensation risk in patients with compensated cirrhosis has yet been fully investigated.
The objective of this study was to investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.
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. 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.
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. 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), model for end-stage liver disease score (tAUC = 0.66), Child-Pugh score (tAUC = 0.65), or 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 decom
The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis. Those patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.
The ALBI score represents an outstanding non-invasive scoring system, enabling clinicians to make precise decisions regarding the monitoring and guidance of treatment for patients with compensated cirrhosis.