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

Abstract

The (albumin-bilirubin) 'ALBI' score is an index of 'liver function' that was recently developed to assess prognosis in patients with hepatocellular carcinoma, irrespective of the degree of underlying liver fibrosis. Other measures of liver function, such as model for end-stage liver disease (MELD) and Child-Pugh score, which were introduced for specific clinical scenarios, have seen their use extended to other areas of hepatology. In the case of ALBI, its application has been increasingly extended to chronic liver disease in general and in some instances to non-liver diseases where it has proven remarkably accurate in terms of prognosis. With respect to chronic liver disease, numerous publications have shown that ALBI is highly prognostic in patients with all types and stages of chronic liver disease. Outside of liver disease, ALBI has been reported as being of prognostic value in conditions ranging from chronic heart failure to brain tumours. Whilst in several of these reports, explanations for the relationship of liver function to a clinical condition have been proposed, it has to be acknowledged that the specificity of ALBI for liver function has not been clearly demonstrated. Nonetheless, and similar to the MELD and Child-Pugh scores, the lack of any mechanistic basis for ALBI's clinical utility does not preclude it from being clinically useful in certain situations. Why albumin and bilirubin levels, or a combination thereof, are prognostic in so many different diseases should be studied in the future.

Keywords: ALBI, albumin-bilirubin; APRI, aspartate aminotransferase-to-platelet ratio index; HCC, hepatocellular carcinoma; MELD, model for end-stage liver disease; hepatocellular carcinoma; liver fibrosis; liver function; liver-related diseases; non-liver-related diseases; prognosis.

Fig. 1

Schematic representation of the changes of ALBI score in comparison to FIB-4 index and MELD score, in association with the progression of liver diseases to end-stage liver disease. ALBI score increases earlier than MELD score and before the development of cirrhosis, revealing slight deterioration in liver function. Liver function deteriorates with the treatment of HCC and may be restored by the eradication or suppression of viral hepatitis. ALBI, albumin-bilirubin; FIB-4, fibrosis-4; HCC, hepatocellular carcinoma; MELD, model for end-stage liver disease.