medwireNews: Research shows that the albumin–bilirubin (ALBI) score is a significant determinant of the long-term prognosis of patients with hepatitis B virus (HBV)-associated cirrhosis, outplaying both the Child–Pugh and model for end-stage liver disease (MELD) scores for this purpose.
Ke-Qing Shi, from the First Affiliated Hospital of Wenzhou Medical University in Zhejiang, China, and co-investigators explain that the ALBI score was developed to assess the severity of hepatic dysfunction in patients with hepatocellular carcinoma, but that its applicability to HBV-related cirrhosis remains to be clarified.
In their study, multivariate analysis of data from 806 chronic HBV patients diagnosed with liver cirrhosis between 2010 and 2015 showed that the ALBI score was one of only two factors significantly associated with mortality at all timepoints over a 3-year period (p=0.000 for all). Age was the second factor.
And area under the receiver operating characteristic curve (AUC) analysis showed that the ALBI score predicted survival at 12, 24, and 36 months with an accuracy of 78.7%, 83.0%, and 83.3%, respectively.
This was significantly higher than the accuracy of the MELD score at the same timepoints, at 69.3%, 71.7%, and 74.4%, respectively, and that of the Child–Pugh score, with corresponding rates of 64.1%, 64.9%, and 65.7% (p<0.001 for all comparisons except for the MELD score at 12 months for which p=0.003).
Of note, the three models did not differ significantly in terms of predicting early mortality, with comparable AUCs at the 3-month timepoint, “strongly” suggesting that the ALBI score has greater value in assessing long-term prognosis, say Shi et al.
Moreover, participants categorized as ALBI grade 1 (≤−2.60) had significantly longer life expectancy than those classed as grade 2 (>−2.60, ≤−1.39; p=0.0002), who in turn fared significantly better than grade 3 patients (>−1.39; p<0.0001).
This survival difference between ALBI grades remained apparent even among patients within the same Child–Pugh class, the authors report in the Journal of Viral Hepatitis.
Noting the usefulness of the ALBI score in predicting long-term outcomes of patients with HBV-related cirrhosis, they nonetheless point out that “[m]ultiple-centre and high-quality studies with large sample size and longer follow-up will be needed to further explore the applicability of [the] ALBI score” in this patient population.
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