The Association of Albumin-Bilirubin (ALBI) Grade with Mortality Risk in Trauma Patients with Liver Injuries

Abstract

Introduction The albumin-bilirubin (ALBI) grade objectively assesses liver function with better performance than the Child-Pugh and end-stage liver disease scores. However, the evidence is lacking on the ALBI grade in trauma cases. This study aimed to identify the association between the ALBI grade and mortality outcomes in trauma patients with liver injury. Methods Data from 259 patients with traumatic liver injury at a level I trauma center between January 1, 2009, and December 31, 2021 were retrospectively analyzed. Independent risk factors for predicting mortality were identified using multiple logistic regression analysis. Participants were characterized by ALBI score into grade 1 (≤ −2.60, n = 50), grade 2 (−2.60 < and ≤ −1.39, n = 180), and grade 3 (> −1.39, n = 29). Results Compared to survival (n = 239), death (n = 20) was associated with a significantly lower ALBI score (2.8±0.4 vs 3.4±0.7, p < 0.001). The ALBI score was a significant independent risk factor for mortality (OR, 2.79; 95% CI, 1.27–8.05; p = 0.038). Compared with grade 1 patients, grade 3 patients had a significantly higher mortality rate (24.1% vs 0.0%, p < 0.001) and a longer hospital stay (37.5 days vs 13.5 days, p < 0.001). Discussion This study showed that ALBI grade is a significant independent risk factor and an useful clinical tool to discover liver injury patients who are more susceptible to death.

A High De Ritis Ratio is Associated with Mortality in Adult Trauma Patients

“…35 However, our Trauma Registration System had 1.54% of trauma victims with liver injury. 36 Notably, AST and ALT play important roles in carbohydrate and protein metabolism, which is a component of the malate-aspartate shuttle pathway that allows NADH/NAD+ conversion 2 and is involved in aerobic glycolysis, whereas ALT plays a crucial role in the glucose-alanine cycle to produce glucose to meet glucose requirements. 5 Due to the fact that AST and ALT activate nucleotides and non-essential amino acids engaged in aerobic glycolysis and boost glutamine metabolism in growing cancer cells, [37][38][39][40] the De Ritis ratio is associated with tumor metabolism in numerous tumors that utilize glucose.…”

Role of albumin-bilirubin score in non-malignant liver disease

“…Recently, Chou et al [ 37 ] explored the application of ALBI score for traumatic liver injury. Research has found that the ALBI score is independently associated with the risk of mortality, and patients with ALBI grade III have significantly higher mortality rates and longer hospital stays compared to those with lower ALBI grades.…”

Evaluation of the Easy Albumin–Bilirubin Score as a Prognostic Tool for Mortality in Adult Trauma Patients in the Intensive Care Unit: A Retrospective Study

“…Regarding pre-existing health conditions, there were considerably higher rates of comorbidities, such as hypertension (HTN), coronary artery disease (CAD), congestive heart disease (CHF), and end-stage renal disease (ESRD), in the deceased patients than in those who survived. Deceased patients also presented with notably lower Glasgow Coma Scale (GCS) scores (median [IQR, Q1-Q3], GCS:7 [3][4][5][6][7][8][9][10][11][12][13][14]) but higher injury severity scores (ISS) (25 [20][21][22][23][24][25][26][27][28][29][30][31][32][33]) than individuals who survived (GCS:15 [9][10][11][12][13][14][15], ISS:20 [16][17][18][19][20][21][22][23][24][25]; p < 0.001). The patients who died had a significantly shorter length of stay in the ICU than those who survived (5.2 days vs. 13.6 days; p < 0.001).…”

“…Notably, the applicability of the ALBI score has extended beyond HCC [13][14][15][16][17], thereby demonstrating its prognostic value in gastric cancer [18], lung cancer [19][20][21], esophageal cancer [22], and medulloblastoma [23]. Additionally, it is strongly associated with mortality in non-hepatologic conditions, such as aortic dissection [24], heart failure [25,26], acute pancreatitis [27], and trauma [28].…”

“…Higher ALBI grades were associated with a 2.06-fold increased risk of poor overall survival in patients with cancer who underwent liver resection [37]. Not only can the ALBI grade explain the risk of mortality in patients with moderate-or early-stage liver diseases who are undergoing liver resection [3], but it may also be applicable to trauma patients with liver injuries and may act as a surrogate for liver function [28]. According to the findings of a multivariate logistic regression study [28], the ALBI score was related to a mortality risk that increased by 2.42-fold in patients who suffered liver damage from trauma.…”