Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach—The ALBI Grade

Abstract

A B S T R A C T PurposeMost patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade. Patients and MethodsWe developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n ϭ 5,097) and other clinical situations (patients undergoing resection [n ϭ 525] or sorafenib treatment for advanced HCC [n ϭ 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n ϭ 501). ResultsThe model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function. ConclusionThe ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.

Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective study

“…Grades of HE and ascites were evaluated according to the relevant guidelines (15,16). The ALBI, Child-Pugh, and MELD scores were calculated according to the relevant formula (1,5,6).…”

“…Recently, the albumin-bilirubin (ALBI) score has been established as a more convenient and evidence-based model to assess the severity of liver dysfunction in patients with hepatocellular carcinoma (HCC) (1,2). The major advantage is that the prognostic value is comparable between the ALBI and Child-Pugh scores, but two subjective variables [i.e., ascites and hepatic encephalopathy [HE]] included in the Child-Pugh score are excluded from the ALBI score.…”

Value of the albumin‑bilirubin score in the evaluation of hepatitis B virus‑related acute‑on‑chronic liver failure, liver cirrhosis, and hepatocellular carcinoma

“…The albumin (Alb)-bilirubin (ALBI) score is a newly developed, simple, and objective scoring system for assessing the severity of liver function damage via only two indicators: bilirubin and Alb. The ALBI score may be used to evaluate the liver function damage and prognosis of patients with liver cancer (12,13). This score has been reported to have predictive value for in-hospital mortality in patients with primary biliary cirrhosis or LC combined with upper gastrointestinal bleeding (14,15).…”

Reply

“…Moreover, we have also explored the role of the albumin-bilirubin (ALBI) score, a newly developed HCC prognostic score in patients undergoing assessment for liver resection. (3,4) In our cohort (n 5 67) ALBI was the only factor significantly correlated with survival, independently of Child-Pugh score and HVPG. Interestingly, of resected patients, only two (4%) were classified as ALBI 2, suggesting that ALBI 2 patients are unlikely to be considered suitable candidates for resection.…”