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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
The utility of ALBI score in predicting decompensation risk in patients with compensated cirrhosis has yet been fully investigated.
Research objectives
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.
Research 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. 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.
Research 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. 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 decompensation in patients of the high-risk group was 23.33 (95%CI: 3.88-140.12, P = 0.001).
Research conclusions
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.
Research perspectives
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.
