The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis

Musa Salmanoğlu; Süleyman Baş; Yasemin Armutçuoğlu; İrfan Küçük

doi:10.38053/acmj.1848023

The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis

Abstract

Aims: The albumin-bilirubin (ALBI) score has been evaluated in various liver diseases, however its clinical relevance in alcoholassociated liver disease (ALD) remains unclear. This study aimed to evaluate whether the ALBI score reflects disease severity in patients with alcohol-associated hepatitis (AH) and alcohol-associated cirrhosis (AC). Methods: In this retrospective case control study, 51 AH patients, 39 AC patients, and 48 healthy controls (HCs) were included. The ALBI score was calculated for all participants. The Child-Pugh classification (CPC A-C) was recorded for AC, while Maddrey’s Discriminant Function (MDF) for AH. The Model for End-Stage Liver Disease Sodium (MELD-Na) score was calculated for both patient groups, and the Fibrosis-4 (FIB-4) index was calculated in all participants. Results: Mean ALBI scores were highest in the AH patients and the lowest in the HCs (p<0.001). Statistically significant differences were observed between the AH and AC groups, AH and HC groups, and AC and HC groups (all p<0.001). In the AH group, no significant correlation was observed between the ALBIs and MDF, however, ALBI scores showed positive correlations with FIB-4 and MELD-Na scores (p=0.046; p<0.001). Among patients with AC, the lowest mean ALBI scores were observed in the CPC-A subgroup, while the highest were observed in the CPC-C subgroup (p<0.001). ALBI scores were positively correlated with both FIB-4 and MELD-Na scores (p<0.001; p<0.001). Conclusion: Elevated ALBI scores may have diagnostic value and reflect disease severity and hepatic dysfunction in patients with AH and AC.

Keywords

Ethical Statement

ETHICAL DECLARATIONS Ethics Committee Approval: The study was initiated with the approval of the Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital Ethics Committee (Date: 16.02.2024, Decision No: 2024/29). Informed Consent: Written consent was obtained from the patient participating in this study. Conflict of Interest Statement: The authors have no conflicts of interest to declare. Financial Disclosure: The authors declared that this study has received no financial support. Author Contributions: All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.

References

Mackowiak B, Fu Y, Maccioni L, Gao B. Alcohol-associated liver disease. J Clin Invest. 2024;134(3). doi:10.1172/JCI176345
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. doi:10.1002/bjs.1800600817
Leise MD, Kim WR, Kremers WK, Larson JJ, Benson JT, Therneau TM. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology. 2011; 140(7):1952-1960. doi:10.1053/j.gastro.2011.02.017
Maddrey WC, Boitnott JK, Bedine MS, Weber FL, Jr, Mezey E, White RI, Jr. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75(2):193-199.
Xu SX, Yang F, Ge N, Guo JT, Sun SY. Role of albumin-bilirubin score in non-malignant liver disease. World J Gastroenterol. 2024;30(9):999-1004. doi:10.3748/wjg.v30.i9.999
Toyoda H, Johnson PJ. The ALBI score: From liver function in patients with HCC to a general measure of liver function. JHEP Rep. 2022;4(10): 100557. doi:10.1016/j.jhepr.2022.100557
Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550-558. doi:10.1200/JCO.2014.57.9151
Chen Q, Zhong R, Wang Y, et al. The albumin-bilirubin score as a predictor of liver-related mortality in primary biliary cholangitis with compensated cirrhosis. Dig Dis. 2023;41(6):946-956. doi:10.1159/000531557

Wang J, Zhang Z, Yan X, et al. Albumin-Bilirubin(ALBI) as an accurate and simple prognostic score for chronic hepatitis B-related liver cirrhosis. Dig Liver Dis. 2019;51(8):1172-1178. doi:10.1016/j.dld.2019.01.011
Song Y, Yang H, Lin L, et al. [Albumin-to-bilirubin scores for assessing the prognosis in autoimmune hepatitis-related cirrhosis]. Zhonghua Gan Zang Bing Za Zhi. 2019;27(10):772-776. doi:10.3760/cma. j.issn.1007-3418.2019.10.007.
Fragaki M, Sifaki-Pistolla D, Orfanoudaki E, Kouroumalis E. Comparative evaluation of ALBI, MELD, and Child-Pugh scores in prognosis of cirrhosis: is ALBI the new alternative?. Ann Gastroenterol. 2019;32(6):626-632. doi:10.20524/aog.2019.0417
Imamura T, Okamura Y, Sugiura T, et al. Clinical significance of preoperative albumin-bilirubin grade in pancreatic cancer. Ann Surg Oncol. 2021;28(11):6223-6235. doi:10.1245/s10434-021-09593-9
Koh HH, Cho ES, Lee JH, et al. Association of albumin-bilirubin grade and myosteatosis with its prognostic significance for patients with colorectal cancer. Ann Surg Oncol. 2022;29(6):3868-3876. doi:10.1245/s10434-022-11445-z
Sungur A, Sungur MA, Yıldırımtürk Ö. Effect of albumin-bilirubin score on prognosis in ambulatory heart failure patients with reduced ejection fraction. Turk Kardiyol Dern Ars. 2023. doi:10.5543/tkda.2023.04488
Shi L, Zhang D, Zhang J. Albumin-bilirubin score is associated with in-hospital mortality in critically ill patients with acute pancreatitis. Eur J Gastroenterol Hepatol. 2020;32(8):963-970. doi:10.1097/MEG. 0000000000001753
First MB. Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis. 2013;201(9):727-729. doi: 10.1097/NMD.0b013e3182a2168a
Crabb DW, Bataller R, Chalasani NP, et al. standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis: recommendation from the NIAAA alcoholic hepatitis consortia. Gastroenterology. 2016;150(4):785-790. doi:10.1053/j.gastro. 2016.02.042
Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46(1):32-36. doi:10.1002/hep.21669
Cholongitas E, Papatheodoridis GV, Vangeli M, Terreni N, Patch D, Burroughs AK. Systematic review: the model for end-stage liver disease--should it replace Child-Pugh's classification for assessing prognosis in cirrhosis?. Aliment Pharmacol Ther. 2005;22(11-12):1079-1089. doi: 10.1111/j.1365-2036.2005.02691.x
Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797-805. doi: 10.1002/hep.21563
Navadurong H, Thanapirom K, Wejnaruemarn S, et al. Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis. World J Gastroenterol. 2023;29(32):4873-4882. doi:10.3748/wjg.v29.i32.4873
Li N, Liu H, Xue Y, et al. Targetable Brg1-CXCL14 axis contributes to alcoholic liver injury by driving neutrophil trafficking. EMBO Mol Med. 2023;15(3):e16592. doi:10.15252/emmm.202216592
Artru F, Bou Saleh M, Maggiotto F, et al. IL-33/ST2 pathway regulates neutrophil migration and predicts outcome in patients with severe alcoholic hepatitis. J Hepatol. 2020;72(6):1052-1061. doi:10.1016/j.jhep. 2019.12.017
Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42(1):S100-S107. doi:10.1016/j.jhep. 2004.11.015
Suh B, Yun JM, Park S, et al. Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB-4 liver fibrosis index. Cancer. 2015;121(21):3818-3825. doi:10.1002/cncr.29577
Khatua CR, Anirvan P, Panigrahi MK, Singh SP. Admission albumin-bilirubin score is inferior to MELD, MELD-Na+ and Child-Turcotte-Pugh score in predicting survival in indian patients with alcohol-associated liver disease. JTGCH. 2025;3(3):117-123. doi:10.14218/JTG. 2025.00004
Chen RC, Cai YJ, Wu JM, et al. Usefulness of albumin-bilirubin grade for evaluation of long-term prognosis for hepatitis B-related cirrhosis. J Viral Hepat. 2017;24(3):238-245. doi:10.1111/jvh.12638
Demirors B, Shekouhi R, Jimenez PB, et al. Redefining the albumin-bilirubin score: Predictive modeling and multidimensional integration in liver and systemic disease. World J Gastroenterol. 2025;31(34):110602. doi:10.3748/wjg.v31.i34.110602
Zhang LF, Chen LX, Yang WJ, Hu B. Albumin-bilirubin score in non-malignant liver and other diseases. World J Gastroenterol. 2024;30(41): 4481-4483. doi:10.3748/wjg.v30.i41.4481

Details

Primary Language

English

Subjects

Gastroenterology and Hepatology

Journal Section

Research Article

Authors

Musa Salmanoğlu ^*
0000-0002-5050-531X
Türkiye

Süleyman Baş
0000-0002-5883-445X
Türkiye

Yasemin Armutçuoğlu
0009-0007-9817-2896
Türkiye

İrfan Küçük
0000-0001-7449-8276
Türkiye

Publication Date

March 10, 2026

Submission Date

December 24, 2025

Acceptance Date

February 5, 2026

Published in Issue

Year 2026 Volume: 8 Number: 2

DOI

https://doi.org/10.38053/acmj.1848023

IZ

https://izlik.org/JA59AZ27ME

Cite

RIS / Bibtex

APA

Salmanoğlu, M., Baş, S., Armutçuoğlu, Y., & Küçük, İ. (2026). The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis. Anatolian Current Medical Journal, 8(2), 257-264. https://doi.org/10.38053/acmj.1848023

AMA

1.Salmanoğlu M, Baş S, Armutçuoğlu Y, Küçük İ. The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis. Anatolian Curr Med J / ACMJ / acmj. 2026;8(2):257-264. doi:10.38053/acmj.1848023

Chicago

Salmanoğlu, Musa, Süleyman Baş, Yasemin Armutçuoğlu, and İrfan Küçük. 2026. “The Albumin–bilirubin Score Can Reflect Disease Severity in Alcohol-Associated Hepatitis and Cirrhosis”. Anatolian Current Medical Journal 8 (2): 257-64. https://doi.org/10.38053/acmj.1848023.

EndNote

Salmanoğlu M, Baş S, Armutçuoğlu Y, Küçük İ (March 1, 2026) The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis. Anatolian Current Medical Journal 8 2 257–264.

IEEE

[1]M. Salmanoğlu, S. Baş, Y. Armutçuoğlu, and İ. Küçük, “The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 2, pp. 257–264, Mar. 2026, doi: 10.38053/acmj.1848023.

ISNAD

Salmanoğlu, Musa - Baş, Süleyman - Armutçuoğlu, Yasemin - Küçük, İrfan. “The Albumin–bilirubin Score Can Reflect Disease Severity in Alcohol-Associated Hepatitis and Cirrhosis”. Anatolian Current Medical Journal 8/2 (March 1, 2026): 257-264. https://doi.org/10.38053/acmj.1848023.

JAMA

1.Salmanoğlu M, Baş S, Armutçuoğlu Y, Küçük İ. The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis. Anatolian Curr Med J / ACMJ / acmj. 2026;8:257–264.

MLA

Salmanoğlu, Musa, et al. “The Albumin–bilirubin Score Can Reflect Disease Severity in Alcohol-Associated Hepatitis and Cirrhosis”. Anatolian Current Medical Journal, vol. 8, no. 2, Mar. 2026, pp. 257-64, doi:10.38053/acmj.1848023.

Vancouver

1.Musa Salmanoğlu, Süleyman Baş, Yasemin Armutçuoğlu, İrfan Küçük. The albumin–bilirubin score can reflect disease severity in alcohol-associated hepatitis and cirrhosis. Anatolian Curr Med J / ACMJ / acmj. 2026 Mar. 1;8(2):257-64. doi:10.38053/acmj.1848023