The albumin–bilirubin score as a predictor of outcomes in Japanese patients with PBC: an analysis using time-dependent ROC

Abstract

The albumin–bilirubin (ALBI) score is calculated using only serum albumin and bilirubin levels, and was developed as a simple method to assess hepatic function. In this study, a total of 409 patients with primary biliary cholangitis (PBC) were enrolled between March 1990 and October 2018. The predictive performances of the ALBI score and other well-established prognostic scores were compared using time-dependent receiver operating characteristic (ROC) analysis. During the follow-up period, 60 patients died, 45 due to liver-related diseases and 15 due to non-liver-related diseases, and 16 patients underwent liver transplantation. Time-dependent ROC analysis showed that the ALBI score has higher the areas under the ROC curves (AUROCs) than the Child–Pugh (C–P) score at each time point; AUROCs at 3, 5, and 10 years after the start of follow-up were 0.94, 0.91, and 0.90 for the ALBI score, and 0.89, 0.88, and 0.82 for the C–P score, respectively. The ALBI score showed the highest AUROCs within 2 years after the start of observation; beyond 2 years, however, the Mayo score had better prognostic ability for mortality and liver transplantation. The ALBI score/grade, derived from objective blood tests, and the Mayo score were superior prognostic tools in PBC patients.

Prognostic utility of albumin-bilirubin grade in Japanese patients with primary biliary cholangitis

“… 20 , 21 In particular, ALBI score showed the highest AUC values for predicting overall survival and incidence of LT within 2 years after the start of observation in a Japanese PBC cohort of 409 patients. 22 The present study validated the efficacy of ALBI grade to predict survival in patients with PBC using a large-scale nationwide database with a median follow-up period of over 5 years. Another strength of this investigation was a relatively high number of cases with advanced disease, including 866 patients at Scheuer’s stage III and 282 patients at stage IV, along with the outcomes of all-cause death in 1,227 patients (14%), liver-related death in 789 patients (9%), and LT in 113 patients (1%).…”

“…The present study confirmed that ALBI score/grade could predict PBC progression, which was in agreement with previous smaller cohorts. [20] , [21] , [22] To our knowledge, this is the largest multicenter cohort study to date evaluating the efficacy of ALBI score/grade in Japanese patients with PBC. We identified two important clinical characteristics: 1) ALBI score/grade may be useful in estimating pathological stage according to Scheuer’s classification, and 2) ALBI grade may be useful in predicting the prognosis of patients with PBC.…”

“…Recently, a novel method was developed in support of the conventional Child–Pugh grade to assess liver function, called the albumin-bilirubin (ALBI) score/grade, which is calculated using only serum albumin and bilirubin values. 19 Although several lines of evidence have demonstrated the usefulness of ALBI score/grade to predict prognosis in patients with PBC, [20] , [21] , [22] the sample sizes and number of institutions were limited. In Japan, nationwide surveys on PBC have been conducted every 3 years since 1980.…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“… Ito et al. 70 Retrospective 409 PBC All PBC ALBI score/grade and the Mayo score were superior prognostic tools among other prognostic tools. Song et al.…”

“…The ALBI score/grade has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various aetiologies, including chronic viral hepatitis B, [63] , [64] , [65] , [66] C, 67 primary biliary cholangitis [68] , [69] , [70] and autoimmune hepatitis 71 ( Table 1 ). This is not surprising as liver function is an important indicator of the progression of liver disease, reflecting how near the patient is towards liver failure and liver-related mortality ( Fig.…”