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

Table 1 The diagnostic strengths, limitations, and recent validation data for tools[19,48-54]

Tool	Type	Main components	Strengths	Limitations	Performance data
AST to platelet ratio index	Lab-based score	AST, platelet count	Inexpensive, widely used in HCV, CHB	Low accuracy in intermediate fibrosis, limited outside viral etiologies	Sensitivity: 34%, specificity: 79% (n = 202, Gür-Altunay and Yürük-Atasoy[48])
Fibrosis-4 index	Lab-based score	Age, AST, ALT, platelet count	Early detection of fibrosis, validated in large cohorts	Reduced specificity in older adults, lab variability	Sensitivity: 65%, specificity: 70% (n = 31753, Blanco-Grau et al[49])
Fibro scan (transient elastography)	Ultrasound-based imaging	Ultrasound-based liver stiffness	Noninvasive, widely used, reproducible	Less accurate in obesity, ascites, narrow intercostal spaces	Sensitivity: 83%, specificity: 61% (n = 1765, Anstee et al[50])
Acoustic radiation force impulse	Ultrasound-based imaging	Ultrasound-based elastography	Combines imaging with ultrasound, good accuracy	Low accuracy in obesity or active inflammation	Sensitivity: 92%, specificity: 82% (n = 108, da Silva Junior et al[51])
Fibro test (fibro sure)	Serum-based composite score	α2-macroglobulin, haptoglobin, GGT, total bilirubin, apolipoprotein A1	Correlating with biopsy in multiple liver diseases	Affected by hemolysis, acute inflammation, gilbert syndrome; needs standardization	Sensitivity: 47%, specificity: 86% (n = 272, Poynard et al[52])
Hepa score	Serum-based composite score	Bilirubin, GGT, hyaluronic acid, α2-macroglobulin, age, gender	High sensitivity/specificity for fibrosis and cirrhosis	Complex, costly, limited routine use	Sensitivity 96.8%, specificity 100% (n = 74, Cylwik et al[53])
AST/ALT ratio	Lab ratio	AST, ALT	Simple, potential biomarker for non-alcoholic fatty liver disease	Nonspecific, low modern utility	Sensitivity: 70%, specificity: 65% (n = 4753, Xuan et al[54])
Mayo score	Prognostic score	Age, serum bilirubin, serum albumin, prothrombin time (INR), edema	Accurate prediction of transplant-free survival in PBC; non-invasive, well-validated	Specific to PBC (not a fibrosis staging tool), may be affected by non-hepatic factors (hemolysis, sepsis)	C-statistics = 0.702 (95%CI: 0.653-0.751) (baseline); 0.740 (95%CI: 0.690-0.791) (after 1 year) (n = 397, Feng et al[19])

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyltransferase; INR: International normalized ratio; HCV: Hepatitis C virus; CHB: Chronic hepatitis B; PBC: Primary biliary cholangitis; 95%CI: 95% confidence interval.