Sethasine S, Teerawongsakul P, Ruamtawee W, Treerasoradaj N, Navadurong H. Added value of the albumin-bilirubin score in predicting liver-related complications and mortality in metabolic-associated steatotic liver disease. World J Gastroenterol 2025; 31(37): 110829 [DOI: 10.3748/wjg.v31.i37.110829]
Corresponding Author of This Article
Huttakan Navadurong, MD, Lecturer, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Bangkok 10300, Thailand. huttakan.nav@nmu.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Supatsri Sethasine, Huttakan Navadurong, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Padoemwut Teerawongsakul, Division of Cardiology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Witchakorn Ruamtawee, Clinical Research Center, Research Facilitation Division, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Nutachat Treerasoradaj, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Author contributions: Sethasine S contributed to conceptualization, methodology, data collection, writing-original draft; Teerawongsakul P contributed to methodology, validation, data curation, data analysis; Ruamtawee W contributed to methodology, statistical analysis, data interpretation; Treerasoradaj N contributed to data collection, data curation; Navadurong H contributed to conceptualization, writing-reviewing and editing.
Institutional review board statement: The study protocol was approved by the Vajira Institutional Review Board Institutional Review Board, Faculty of Medicine Vajira Hospital (No. COA 111/2567).
Informed consent statement: The informed consent was waived due to our study being retrospective study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huttakan Navadurong, MD, Lecturer, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Bangkok 10300, Thailand. huttakan.nav@nmu.ac.th
Received: June 17, 2025 Revised: August 1, 2025 Accepted: August 28, 2025 Published online: October 7, 2025 Processing time: 100 Days and 22.3 Hours
Abstract
BACKGROUND
The albumin-bilirubin (ALBI) score is a marker of liver function and prognosis in hepatocellular carcinoma, with its utility being expanded to various liver conditions. However, its role in predicting long-term outcomes in patients with metabolic-associated steatotic liver disease (MASLD) remains unknown.
AIM
To determine the ability of the ALBI score in predicting the 8-year liver-related complications and all-cause mortality in MASLD.
METHODS
We conducted a retrospective longitudinal cohort study of 1163 patients with MASLD. MASLD was defined by a controlled attenuation parameter of > 254 dB/m on transient elastography, at least one cardiometabolic risk factor, and no excessive alcohol consumption. Odds ratio regression was employed to create based-prognostic scores with and without ALBI. The predictive accuracy of both scores, the ALBI score, and fibrosis-4 (FIB-4) were assessed using area under the receiving operating characteristic curve (AUROC) analysis and compared using the DeLong test.
RESULTS
Over 8 years, 100 (8.6%) participants of liver-related complications, and 86 (7.4%) died (30.2% of prior liver complications). ALBI had greater accuracy for predicting liver-related complications [AUROC = 0.72, 95% confidence interval (CI): 0.66-0.77] compared with the based-prognostic score (AUROC = 0.67, 95%CI: 0.62-0.73) and FIB-4 (AUROC = 0.64, 95%CI: 0.58-0.70). Additionally, ALBI was superior to the based-prognostic score and FIB-4 (AUROC = 0.81, 95%CI: 0.76-0.86 vs AUROC = 0.78, 95%CI: 0.72-0.83 and AUROC = 0.72, 95%CI: 0.65-0.78, respectively) for predicting all-cause mortality. Incorporating ALBI improved the prognostic score’s accuracy for both outcomes (liver complications: AUROC = 0.74, 95%CI: 0.68-0.79; all-cause mortality: AUROC = 0.83, 95%CI: 0.79-0.88).
CONCLUSION
The ALBI score is a robust and independent predictor of long-term liver-related complications and all-cause mortality in patients with MASLD. ALBI may have potential clinical applications for long-term risk stratification in MASLD management.
Core Tip: The albumin-bilirubin (ALBI) score, which was developed for hepatocellular carcinoma, showed a strong predictive value for long-term liver-related complications and all-cause mortality in patients with metabolic-associated steatotic liver disease (MASLD). In a cohort of 1163 patients with MASLD, ALBI outperformed fibrosis-4 and the existing prognostic models. Incorporating ALBI significantly improved the predictive accuracy for long-term complications and mortality, suggesting its potential role as a valuable and noninvasive tool for long-term risk stratification in MASLD.
