Prognostic Role of Albumin, Bilirubin, and ALBI Scores: Analysis of 1000 Patients with Hepatocellular Carcinoma Undergoing Radioembolization

Abstract

Introduction: We compared the efficacy of the ALBI (albumin–bilirubin) score to the established Child–Pugh (CP) grade in hepatocellular carcinoma (HCC) patients treated with yttrium-90 radioembolization (Y90). We further assessed the individual contributions of albumin and bilirubin to survival prediction. Methods: 1000 consecutive HCC patients treated with Y90 were included. Overall survival (OS) was assessed using Kaplan Meier analysis. Sub-stratification analyses were performed using CP and ALBI and in subgroups determined by United Network for Organ Sharing (UNOS) or Barcelona Clinic Liver Cancer (BCLC) staging. The independent impact (hazard ratio (HR)) of ALBI, CP, albumin, and bilirubin on survival was assessed using Cox proportional hazards analysis. Results: Median OS for ALBI 1, 2, and 3 grades was 46.7, 19.1, and 8.8 months, respectively. The HR for death for ALBI 2 vs. ALBI 1 was 3.39 (1.75–6.57); ALBI 3 vs. ALBI 1 was 7.58 (3.89–14.79); and the c-index was 0.623. Median OS for CP A, B, and C was 21.7, 11.3, and 6.0 months, respectively. The HR for death for CP B vs. CP A was 2.04 (1.71–2.43); CP C vs. CP A was 3.27 (2.08–5.14); and the c-index was 0.616. Stratified OS showed unique prognostic groups identified by ALBI within CP-B and CP-C. Median OS for albumin grades 1, 2, and 3 was 46.0, 17.1, and 9.1 months, respectively. Median OS for bilirubin grades 1, 2, and 3 was 15.6, 21.0, and 5.8 months, respectively. The HR for death for albumin 2 vs. 1 was 2.48 (1.81–3.41); albumin 3 vs. 1 was 4.74 (3.44–6.54); and the c-index was 0.640. The HR for death for bilirubin 2 vs. 1 was 1.09 (0.82–1.44); bilirubin 3 vs. 1 was 2.37 (1.66–3.40); and the c-index was 0.533. Conclusions: ALBI outperforms CP in survival prognosis in Y90 treated patients. On sub-analyses, serum albumin (not bilirubin) appears to be the main driver of survival prediction. Our study supports the prognostic ability of ALBI and may suggest a role of albumin alone as a biomarker for patients with HCC.

Assessing the Prediction Effect of Various Prognosis Model for 28-Day Mortality in Acute-on-Chronic Liver Failure Patients

“…16 The ALBI score uses albumin and bilirubin levels to show liver damage, and it has been confirmed to be a useful score in reflecting the prognosis of hepatocellular carcinoma. 17 Our data showed that the ALBI score and CLIF-SOFA score had similar efficacy in assessing the prognosis of ACLF patients. One single-center study indicated that the ALBI score was more effective and accurate than Child-Pugh and MELD scores in predicting the longterm prognosis for HBV-ACLF.…”

Albumin to alkaline phosphatase ratio: does it predict survival in grade 1 and grade 2 neuroendocrine tumors?

“…Additionally, there are various prognostic parameters which involve albumin in itself such as albumin-globulin, albuminfibrinogen, albumin-bilirubin, prognostic nutritional index. Previous studies established the association of low levels of all these parameters with poor prognosis (22)(23)(24)(25)(26). Taken together, these results establish the prognostic value of albumin either alone or combined with different parameters.…”

Systemic Inflammatory Biomarkers, Especially Fibrinogen to Albumin Ratio, Predict Prognosis in Patients with Pancreatic Cancer

“…For instance, tumor necrosis factor-α and IL-6 inhibit the synthesis of albumin, causing hypoalbuminemia [25]. Present studies have indicated that hyperfibrinogenemia was significantly correlated with shorter OS in patients with advanced PC and hypoalbuminemia is negatively correlated with prognosis in patients with hepatocellular carcinoma and diffuse large B-cell lymphoma [26][27][28]. Based on the above studies, researchers were keen to explore whether FAR was also associated with prognosis.…”