Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis

Table 1 Baseline characteristics of patients with compensated cirrhosis, n (%)

Variable	n = 123
Age, yr, mean (SD)	63.9 (12.3)
Male	72 (58.5)
Body mass index, kg/m2, mean (SD)	24.5 (3.7)
Obesity	54 (43.9)
Diabetes	33 (26.8)
Etiology of disease
HBV	43 (35)
HCV	30 (24.4)
NASH	29 (23.6)
Alcohol	19 (15.4)
Autoimmune hepatitis	2 (1.6)
Laboratory data
Creatinine, mg/dL, median (IQR)	0.8 (0.7-0.9)
Albumin, g/dL, median (IQR)	4 (3.4-4.3)
Bilirubin, mg/dL, median (IQR)	0.9 (0.6-1.5)
AST, U/L, median (IQR)	44 (28-66)
ALT, U/L, median (IQR)	33 (24-58)
Platelets, × 109/L, median (IQR)	142 (104-200)
INR, median (IQR)	1.1 (1-1.2)
Child-Pugh grade
A	113 (91.9)
B	10 (8.1)
Decompensation event	17 (13.8)
Variceal bleeding	8 (47)
Ascites development	5 (29.4)
Grade 3 or 4 hepatic encephalopathy	4 (23.6)
MELD, median (IQR)	8.7 (7.8-10.1)
ALBI score, median (IQR)	-2.63 (-2.91 to -2.06)
ALBI grade
1	64 (52)
2	53 (43.1)
3	6 (4.9)
ALBI-FIB4 score, median (IQR)	-2.79 (-3.28 to -1.93)
FIB-4 score, median (IQR)	3.2 (1.8-5.3)

NASH: Nonalcoholic steatohepatitis; HBV: Hepatitis B virus; HCV: Hepatitis C virus; AST: Aspartate transaminase; ALT: Alanine transaminase; INR: International normalized ratio; MELD: Model for end-stage liver disease; ALBI: Albumin-bilirubin; FIB-4: Fibrosis-4; SD: Standard deviation; IQR: Interquartile range

Table 2 Predictors of decompensation in patients with compensated cirrhosis

Variable	Univariate		Multivariate
	Hazard ratio (95%CI)	P value	Adjusted hazard ratio (95%CI)	P value
Age	1.01 (0.97-1.05)	0.47	1.01 (0.97-1.06)	0.56
Male	0.58 (0.22-1.50)	0.26	0.55 (0.18-1.69)	0.29
Creatinine	1.20 (0.83-1.74)	0.31
Albumin	0.10 (0.03-0.26)	< 0.001
Bilirubin	1.21 (1.02-1.43)	0.02
AST	1.00 (0.99-1.00)	0.34
ALT	1.01 (1.00-1.02)	0.01
Platelets	0.99 (0.98-1.00)	0.27
INR	1.58 (0.11-22.29)	0.73
ALBI score	8.31 (3.48-19.85)	< 0.001	4.18 (1.40-12.53)	0.01
MELD score	1.11 (1.02-1.21)	0.01	1.07 (0.92-1.24)	0.34
ALBI-FIB4 score	2.30 (1.60-3.31)	< 0.001	1.73 (0.82-3.64)	0.15
FIB-4 score	1.02 (0.92-1.13)	0.67
Child-Pugh score	1.98 (1.15-3.39)	0.01	1.26 (0.61-2.58)	0.54

AST: Aspartate transaminase; ALT: Alanine transaminase; INR: International normalized ratio; MELD: Model for end-stage liver disease; ALBI: Albumin-bilirubin; FIB-4: Fibrosis-4; CI: Confidence interval.

Table 3 Comparative performance of each prognostic score for predicting decompensation at 3 years

Prognostic score	tAUC	P value vs ALBI score
ALBI	0.86 (0.78-0.92)	Reference
MELD	0.66 (0.56-0.75)	< 0.001
ALBI-FIB4	0.77 (0.68-0.86)	0.04
FIB-4	0.48 (0.38-0.58)	< 0.001
Child-Pugh	0.65 (0.55-0.75)	< 0.001

MELD: Model for end-stage liver disease; ALBI: Albumin-bilirubin; FIB-4: Fibrosis-4; tAUC: Time-dependent area under the curve.

Table 4 Decompensation risk stratification based on albumin-bilirubin grade at baseline

ALBI grade	Decompensation at 3-yr (n, %)	P value	OR (95%CI)	P value
1	2/64 (3.1)	-	1.0 (reference)	-
2	12/53 (22.6)	0.003	7.83 (1.75-35.01)	0.007
3	3/6 (50)	< 0.001	23.33 (3.88-140.12)	0.001

ALBI: Albumin-bilirubin; OR: Odds ratio.