Aim: The existence of reliable prognostic indices is of paramount importance in the management of cirrhosis. The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction. The aim of this study was to determine the ALBI score’s mortality prediction among cirrhotics and its comparison with MELD, CTP scores.

Methods: This prospective study included one hundred cirrhotics where we calculated CTP, MELD and ALBI scores were calculated within 24 hours of admission. The mortality was assessed during the hospital stay and follow-up at 2, 4 and 6 months. The diagnostic accuracy of CTP, MELD and ALBI scores for mortality in cirrhotic patients was determined by receiver operating characteristic curve (ROC) analysis.

Results: In the overall analysis, all of the three scores were significantly assess the mortality (CTP AUC=0.917, 95% CI: 0.857–0.977, P<0.0001; MELD AUC=0.935, 95% CI: 0.887–0.982, P<0.0001; ALBI AUC =0.964, 95% CI: 0.924–1.003, P<0.0001). The best cut-off values for CTP, MELD and ALBI were at >12.5 (sensitivity = 75.86%, specificity = 97.18%), >22.5 (sensitivity = 100%, specificity = 84.51%) and >-1.38 (sensitivity = 100%, specificity = 94.37%) with diagnostic accuracy of 91%, 89% and 96% respectively.

Conclusion: The fact that ALBI score uses only two convenient parameters, readily obtained by easily accessible blood tests, objectively evaluated and being non inferior to CTP and MELD scores indicates that ALBI score might be a better mortality predictor in cirrhosis. Therefore, all these favour its applicability in clinical practice as a substitute for the CTP and MELD scores.

Keywords:  Bilirubin, Albumins , Prognosis, Liver Cirrhosis.

1. Blachier M, Leleu H, Peck-Radosavljevic M, Valla D-C and Roudot-Thoraval F. The burden of liver disease in Europe: A review of available epidemiological data. Journal of Hepatology 2013; 58(3):593–608.
2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095- 2128.
3. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg 1964;1:1-85.
4. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-649.
5. Kamath P, Wiesner R, Malinchoc M, Kremers W, Therneau T, Damico G, et al. A model to predict survival in patients with end-stage liver disease. Gastroenterology 2001; 120(5).
6. Kamath PS and Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007;45(3):797–805. Child CG, Turcotte JG. Surgery and portal hypertension. In: Child CG (editor): The liver and portal hypertension. Saunders: Philadelphia; 1964, pp. 50-64.
7. Gheorghe L, Iacob S, Simionov I, Vandan R, Gheoghe C, Iacob R, et al. Natural history of compensated viral B and D cirrhosis. Rom J Gastroenterol 2005; 14:329-335.
8. Cholongitas E, Marelli L, Shusang V, Senzolo M, Rolles K, Patch D, et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transplantation 2006; 12(7):1049-1061.
9. Peng Y, Qi X, Dai J, Li H and Guo X. Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis. Int J Clin Exp Med 2015; 8:751-757.
10. Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Model for end-stage liver disease(MELD) for predicting mortality in patients with acute variceal bleeding. Hepatology 2002; 35(5):1282-1284.
11. Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology. 1987; 7 (4): 660-5.
12. Arroyo V. Pathophysiology, diagnosis and treatment of ascites in cirrhosis. Annals of hepatology. 2002; 1 (2): 72-9.
13. Chan AW, Chan RC, Wong GL, et al. Evaluation of histological staging systems for primary biliary cirrhosis:correlation with clinical and biochemical factors and significance of pathological parameters in prognostication. Histopathology. 2014; 65: 174-86.
14. Peng Y, Qi X, Tang S, Deng H, Li J, Ning Z, Dai J, Hou F,Zhao J, Wang R, Guo X. Child-Pugh, MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure. Expert review of gastroenterology & hepatology. 2016; 10 (8): 971-80.
15. Zou D, Qi X, Zhu C, Ning Z, Hou F, Zhao J, Peng Y, Li J Deng H, Guo X. Albumin-bilirubin score for  predicting the inhospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective  Turk J Gastroenterol. 2016 Mar 1; 27 (2): 180-86.
16. Shao L, Han B, An S, Ma J, Guo X, Romeiro FG, et al. Albumin-to-bilirubin score for assessing the in- hospital death in cirrhosis. Translational Gastroenterology and Hepatology 2017;88.
17. Chen B and Lin S. Albumin-bilirubin (ALBI) score at admission predicts possible outcomes in patients with acute-on-chronic liver failure. Medicine 2017;96(24).
18. Xavier SA, Vilas-Boas R, Carvalho PB, Magalhães JT, Marinho CM and Cotter JB. Assessment of prognostic performance of Albumin–Bilirubin, Child–Pugh, and Model for End-stage Liver Disease scores in patients with liver cirrhosis complicated with acute upper gastrointestinal bleeding. European Journal of Gastroenterology & Hepatology 2018;1.
19. Hsieh YC, Lee KC, Wang YW, et al. Correlation and prognostic accuracy between noninvasive liver fibrosis markers and portal pressure in cirrhosis: Role of ALBI score. PLoS One 2018;13:e0208903.

Ravikumar. P

Madras Medical College, Chennai