Yoğun bakım hastalarında mortaliteyi tahmin etmede albumin-bilirubin skorunun etkinliği

Abstract

Amaç: Hepatoselüler karsinomlu hastalarda karaciğer fonksiyonunu değerlendirmek için geliştirilen Albümin-Bilirubin (ALBI) skoru, yakın dönemde kritik hastalarda prognostik belirteç olarak ilgi görmüştür. Bu çalışmada, yoğun bakım ünitesi (YBÜ) hastalarında ALBI skorunun mortaliteyi öngörmedeki etkinliğinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışmaya, Kasım 2023 ve Kasım 2024 tarihleri arasında, sepsis, solunum yetmezliği, travma, akut nörolojik olaylar ve kardiyak arrest sonrası gibi çeşitli klinik nedenlerle YBÜ'ye kabul edilen 157 erişkin hasta dahil edildi. Klinik veriler, laboratuvar parametreleri ile ALBI, SOFA ve APACHE II skorları YBÜ’ye kabulde değerlendirildi. ALBI skoru, (log10 bilirubin [μmol/L] × 0,66) + (albumin [g/L] × -0,085) formülü ile hesaplandı. Bulgular: Hastaların yaş ortalaması 71,7 ± 18,6 yıl olup, %55,4’ü erkekti. Hastaların %42,7’sinde diabetes mellitus, %21,7’sinde kronik böbrek hastalığı (KBH), %38,9’unda kronik obstrüktif akciğer hastalığı, %73,9’unda kardiyovasküler hastalık ve %19,7’sinde malignite mevcuttu. Genel mortalite oranı %42,7 bulundu. Çok değişkenli Cox regresyon analizinde KBH varlığı (HR: 1,90; %95 GA: 1,07–3,39; p = 0,029), yüksek ALBI skoru (HR: 1,65; %95 GA: 1,03–2,65; p = 0,038) ve yüksek APACHE II skoru (HR: 1,04; %95 GA: 1,00–1,08; p = 0,031) mortalitenin bağımsız prediktörleri olarak saptandı. Sonuç: ALBI skoru, farklı klinik nedenlerle yoğun bakıma yatırılan hastalarda mortalitenin bağımsız bir belirleyicisidir. ALBI skoru, karaciğer fonksiyonu, beslenme durumu ve sistemik inflamasyonu birlikte yansıtarak geleneksel prognostik araçları tamamlamakta ve klinik karar verme süreçlerini destekleyici bir araç olarak kullanılabilir.

Keywords

• ALBI skoru
• yoğun bakım
• mortalite
• prognostik skor
• APACHE II
• SOFA
• albumin
• bilirubin

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Ordu University Non-Interventional Clinical Research Ethics Committee (Date: 20.12.2024, Approval No: 2024/207).

Effectiveness of albumin-bilirubin score in predicting mortality in intensive care patients

Abstract

Aim: The Albumin-Bilirubin (ALBI) score, originally developed to assess liver function in patients with hepatocellular carcinoma, has recently gained attention as a prognostic marker in critically ill patients. This study aimed to evaluate the effectiveness of the ALBI score in predicting mortality among intensive care unit (ICU) patients. Material and Methods: This retrospective study included 157 adult patients admitted to the ICU diverse clinical conditions, including sepsis, respiratory failure, trauma, acute neurological events, and post-cardiac arrest, between November 2023 and November 2024. Clinical data, laboratory parameters, ALBI, SOFA, and APACHE II scores were assessed at ICU admission. The ALBI score is calculated as follows: (log10 bilirubin [μmol/L] × 0.66) + (albumin [g/L] × −0.085). Results: Among the study participants (mean age: 71.7 ± 18.6 years; 55.4% male), 42.7% had diabetes mellitus, 21.7% chronic kidney disease (CKD), 38.9% chronic obstructive pulmonary disease, 73.9% cardiovascular disease, and 19.7% malignancies. The overall mortality rate was 42.7%. Multivariable Cox regression analysis revealed that CKD (HR: 1.90; 95% CI: 1.07–3.39; p = 0.029), higher ALBI scores (HR: 1.65; 95% CI: 1.03–2.65; p = 0.038) and higher APACHE II scores (HR: 1.04; 95% CI: 1.00–1.08; p = 0.031) were independent predictors of mortality. Conclusion: The ALBI score is an independent predictor of mortality among critically ill patients with heterogeneous clinical conditions in general ICU settings. By integrating hepatic dysfunction, nutritional status, and systemic inflammation, ALBI complements traditional prognostic tools and may enhance clinical decision-making and risk stratification.

Keywords

• ALBI score
• intensive care
• mortality
• prognostic score
• APACHE II
• SOFA
• albumin
• bilirubin

References

1. Goncalves-Pereira J, Oliveira A, Vieira T, et al. Critically ill patient mortality by age: long-term follow-up (CIMbA-LT). Ann Intensive Care. 2023;13(1):7.
2. Otero ML, Menezes RC, Ferreira IBB, et al. Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections. Infect Drug Resist. 2020;13:2811-17.
3. Oliveira A, Vieira T, Rodrigues A, et al. Critically ill patients with high predicted mortality: Incidence and outcome. Med Intensiva (Engl Ed). 2024;48(2):85-91.
4. Mehta S and Gill SE. Improving clinical outcomes in sepsis and multiple organ dysfunction through precision medicine. J Thorac Dis. 2019;11(1):21-28.
5. Chung J, Ahn J, and Ryu JA. Beyond SOFA and APACHE II, Novel Risk Stratification Models Using Readily Available Biomarkers in Critical Care. Diagnostics (Basel). 2025;15(9)
6. 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):550-8.
7. Toyoda H and 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.
8. Gou E, Yang Q, Chen J, et al. Association between albumin-bilirubin score and in-hospital mortality in patients with sepsis: Evidence from two large databases. Heliyon. 2024;10(15):e34697.

9. Kuo PJ, Rau CS, Tsai CH, et al. 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. Diagnostics (Basel). 2023;13(22)
10. Wang J, Wang K, Feng G, and Tian X. Association Between the Albumin-Bilirubin (ALBI) Score and All-cause Mortality Risk in Intensive Care Unit Patients with Heart Failure. Glob Heart. 2024;19(1):97.
11. Shi L, Zhang D, and 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):963-70.
12. Mansur A, Mulwande E, Steinau M, et al. Chronic kidney disease is associated with a higher 90-day mortality than other chronic medical conditions in patients with sepsis. Sci Rep. 2015;5:10539.
13. Ismaeil T, Almutairi J, Alshaikh R, Althobaiti Z, Ismaeil Y, and Othman F. Survival of mechanically ventilated patients admitted to intensive care units. Results from a tertiary care center between 2016-2018. Saudi Med J. 2019;40(8):781-88.
14. Motiejunaite J, Deniau B, Blet A, Gayat E, and Mebazaa A. Inotropes and vasopressors are associated with increased short-term mortality but not long-term survival in critically ill patients. Anaesth Crit Care Pain Med. 2022;41(1):101012.
15. Edipoglu IS, Dogruel B, Dizi S, Tosun M, and Cakar N. The association between the APACHE-II scores and age groups for predicting mortality in an intensive care unit: a retrospective study. Rom J Anaesth Intensive Care. 2019;26(1):53-58.
16. Saleh A, Ahmed M, Sultan I, and Abdel-Lateif A. Comparison of the mortality prediction of different ICU scoring systems (APACHE II and III, SAPS II, and SOFA) in a single-center ICU subpopulation with acute respiratory distress syndrome. Egyptian journal of chest diseases and tuberculosis. 2015;64(4):843-48.
17. Liang J, Li Z, Dong H, and Xu C. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: A single-center, retrospective cohort study of 905 patients. Medicine (Baltimore). 2019;98(42):e17592.
18. Tian Y, Yao Y, Zhou J, et al. Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients. Front Med (Lausanne). 2021;8:744907.
19. Sadaka F, EthmaneAbouElMaali C, Cytron MA, Fowler K, Javaux VM, and O'Brien J. Predicting Mortality of Patients With Sepsis: A Comparison of APACHE II and APACHE III Scoring Systems. J Clin Med Res. 2017;9(11):907-10.
20. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
21. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and Acute Dialysis Quality Initiative w. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-12.
22. Li D, Wei Y, Zhang C, et al. Value of SOFA score, APACHE II score, and WBC count for mortality risk assessment in septic patients: A retrospective study. Medicine (Baltimore). 2025;104(20):e42464. 23. Nicholson JP, Wolmarans MR, and Park GR. The role of albumin in critical illness. Br J Anaesth. 2000;85(4):599-610.
23. Atrash AK and de Vasconcellos K. Low albumin levels are associated with mortality in the critically ill: A retrospective observational study in a multidisciplinary intensive care unit. South Afr J Crit Care. 2020;36(2)
24. Duman ZM and Timur B. Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery. Braz J Cardiovasc Surg. 2023;38(2):271-77.
25. Gao X, Li C, Wang Y, et al. Association of albumin-bilirubin grade with short- and long-term mortality in patients with heart failure: a cohort study using restricted cubic splines and propensity score matching. BMC Cardiovasc Disord. 2025;25(1):307.
26. Jurkiewicz M, Szczurek-Wasilewicz W, Skrzypek M, Krych S, Gąsior M, and Szyguła-Jurkiewicz B. Albumin–Bilirubin (ALBI) Score Predicts Long-Term Survival in Elderly Patients with Decompensated Heart Failure. Journal of Clinical Medicine. 2025;14(3):808.