Redefining the albumin-bilirubin score: Predictive modeling and multidimensional integration in liver and systemic disease

Abstract

This editorial comment is on the article by Xu et al. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI’s components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI’s role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily used as an indicator of hepatic reservoir in hepatocellular carcinoma, it has been demonstrated a positive correlation with overall survival, tumor recurrence, and post-hepatectomy liver failure in patients undergoing potentially curative treatments such as liver resection, liver transplantation, and local ablation. Moreover, several studies suggest that ALBI can also predict survival outcomes, treatment-related toxicity, and liver-related complications in patients receiving trans-arterial chemoembolization, radioembolization, external-beam radiotherapy, or systemic therapies. Its growing use in non-malignant liver diseases, including primary biliary cholangitis, cirrhosis, acute and chronic liver failure, and viral hepatitis highlights the need for large, prospective studies. Further studies are warranted to validate the integration of ALBI into routine clinical practice and to clarify its role in guiding prognosis and treatment planning.

Keywords: Albumin-bilirubin score; Liver function assessment; Non-malignant liver disease; Primary biliary cholangitis; Liver transplantation; Noninvasive biomarkers; Prognostic models

Core Tip: The albumin-bilirubin score, originally designed for hepatocellular carcinoma, has emerged as an objective, cost-effective liver function assessment tool in non-malignant liver diseases. This editorial discusses its expanding role across cirrhosis, hepatitis, and transplantation, and highlights recent advances that may enhance its clinical utility.