Added value of the albumin-bilirubin score in predicting liver-related complications and mortality in metabolic-associated steatotic liver disease

doi:10.3748/wjg.v31.i37.110829

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World Journal of Gastroenterology

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1007-9327

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Retrospective Cohort Study

World J Gastroenterol. Oct 7, 2025; 31(37): 110829
Published online Oct 7, 2025. doi: 10.3748/wjg.v31.i37.110829

Table 1 Baseline characteristics of metabolic-associated steatotic liver disease participants, n (%)

Characteristics	Total (n = 1163)	8-year liver-related complications			8-year all-cause mortality
Characteristics	Total (n = 1163)	Yes (n = 100)	No (n = 1063)	P value¹	Yes (n = 86)	No (n = 1077)	P value¹
Age (years), median IQR	56.0 (46.0 to 63.0)	61.5 (52.0 to 68.0)	55.0 (45.0 to 63.0)	< 0.001^a	62.0 (54.0 to 70.0)	55.0 (45.0 to 63.0)	< 0.001^a
Male	587 (50.5)	50 (50.0)	537 (50.5)	0.921	52 (60.5)	535 (49.7)	0.054
BMI (kg/m²), median IQR	26.4 (24.0 to 29.3)	27.6 (24.8 to 31.2)	26.3 (23.9 to 29.2)	0.034^a	25.8 (23.1 to 27.7)	26.4 (24.0 to 29.4)	0.038^a
Overweight/obesity	957 (82.3)	83 (83.0)	874 (82.2)	0.845	61 (70.9)	896 (83.2)	0.004^a
Hypertension	658 (57.8)	66 (68.0)	592 (56.9)	0.033^a	50 (62.5)	608 (57.5)	0.379
Prediabetes/diabetes	809 (81.6)	81 (88.0)	728 (81.0)	0.096	65 (86.7)	744 (81.2)	0.242
Hypertriglyceridemia	310 (29.9)	33 (36.3)	277 (29.3)	0.165	21 (28.0)	289 (30.0)	0.710
Low HDL	312 (30.3)	35 (38.0)	277 (29.5)	0.090	25 (34.3)	287 (30.0)	0.445
AST, median IQR	30.0 (23.0 to 40.0)	35.0 (24.0 to 57.0)	29.0 (23.0 to 39.0)	0.003^a	43.0 (25.0 to 65.0)	29.0 (23.0 to 39.0)	< 0.001^a
ALT, median IQR	33.0 (20.0 to 51.0)	36.5 (21.5 to 54.0)	33.0 (20.0 to 50.0)	0.390	36.0 (22.0 to 55.0)	33.0 (20.0 to 51.0)	0.358
Albumin (g/dL), median IQR	4.2 (4.0 to 4.5)	3.9 (3.6 to 4.2)	4.3 (4.0 to 4.5)	< 0.001^a	3.6 (2.8 to 4.1)	4.3 (4.0 to 4.5)	< 0.001^a
CAP (dB/m), median IQR	298.0 (275.0 to 329.0)	299.0 (278.5 to 325.0)	298.0 (275.0 to 330.0)	0.866	290.0 (271.0 to 312.0)	299.0 (275.0 to 331.0)	0.012^a
Steatosis grade				0.418			0.030^a
S1	383 (32.9)	28 (28.0)	355 (33.4)		36 (41.9)	347 (32.2)
S2	359 (30.9)	36 (36.0)	323 (30.4)		30 (34.9)	329 (30.6)
S3	421 (36.2)	36 (36.0)	385 (36.2)		20 (23.2)	401 (37.2)
LSM (kPa), median IQR	6.9 (5.2 to 11.6)	8.5 (6.1 to 14.9)	6.8 (5.1 to 11.0)	< 0.001^a	11.2 (7.6 to 32.5)	6.8 (5.1 to 10.7)	< 0.001^a
Fibrosis stage				0.035^a			< 0.001^a
F0	514 (44.2)	30 (30.0)	484 (45.5)		18 (20.9)	496 (46.0)
F1	127 (10.9)	11 (11.0)	116 (10.9)		4 (4.7)	123 (11.4)
F2	146 (12.5)	15 (15.0)	131 (12.3)		13 (15.1)	133 (12.4)
F3	138 (11.9)	15 (15.0)	123 (11.6)		13 (15.1)	125 (11.6)
F4	238 (20.5)	29 (29.0)	209 (19.7)		38 (44.2)	200 (18.6)
FIB-4, median IQR	1.3 (0.8 to 2.0)	1.7 (1.1 to 3.6)	1.2 (0.8 to 1.9)	< 0.001^a	2.1 (1.3 to 4.9)	1.2 (0.8 to 1.9)	< 0.001^a
ALBI, median IQR	-3.0 (-3.2 to -2.7)	-2.7 (-2.9 to -2.3)	-3.0 (-3.2 to -2.7)	< 0.001^a	-2.5 (-2.9 to -1.5)	-3.0 (-3.2 to -2.8)	< 0.001^a
ALBI grade				< 0.001^a			< 0.001^a
1	964 (82.9)	61 (61.0)	903 (85.0)		34 (39.5)	930 (86.3)
2	178 (15.3)	28 (28.0)	150 (14.1)		33 (38.4)	145 (13.5)
3	21 (1.8)	11 (11.0)	10 (0.9)		19 (22.1)	2 (0.2)
Advanced fibrosis group	261 (22.4)	35 (35.0)	226 (21.3)	0.002^a	43 (50.0)	218 (20.2)	< 0.001^a
Hepatitis B/C	358 (37.8)	24 (25.5)	334 (39.2)	0.010^a	39 (53.4)	319 (36.5)	0.004^a
Follow-up duration (years), median IQR	4.8 (2.5 to 6.3)	4.9 (2.5 to 6.5)	4.8 (2.5 to 6.3)	0.668	3.1 (1.8 to 5.0)	4.9 (2.6 to 6.4)	< 0.001^a

^aP < 0.05.

¹P value by Pearson’s χ² test or Mann-Whitney U test.

IQR: Interquartile range; BMI: Body mass index; HDL: High-density lipoprotein; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CAP: Controlled attenuation parameter; LSM: Liver stiffness measurement; ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4.

Full Size Table

Table 2 Prognostic performance of albumin-bilirubin and other non-invasive scores on 8-year liver-related complications and all-cause mortality

Scores (n = 1163)	8-year liver-related complications	8-year all-cause mortality
Based-prognostic score
AUROC (95%CI)	0.67 (0.62-0.73)	0.78 (0.72-0.83)
Euclidian cut-off values	≥ -2.39	≥ -2.60
Sensitivity/specificity (%)	62.89/64.75	72.09/72.98
PPV/NPV (%)	14.25/94.93	12.85/96.48
Positive/negative LR	1.78/0.57	2.67/0.38
Correctly classified (%)	64.59	72.91
Based-prognostic score plus ALBI
AUROC (95%CI)	0.74 (0.68-0.79)	0.83 (0.79-0.88)
Euclidian cut-off values	≥ -2.44	≥ -2.70
Sensitivity/specificity (%)	65.98/67.72	74.42/75.95
PPV/NPV (%)	16.00/95.53	14.50/97.02
Positive/negative LR	2.04/0.50	3.09/0.34
Correctly classified (%)	67.57	75.84
ALBI
AUROC (95%CI)	0.72 (0.66-0.77)	0.81 (0.76-0.86)
Euclidian cut-off values	≥ -2.82	≥ -2.77
Sensitivity/specificity (%)	66.00/66.60	72.09/72.52
PPV/NPV (%)	15.68/95.42	17.32/97.02
Positive/negative LR	1.98/0.51	2.62/0.38
Correctly classified (%)	66.55	72.48
FIB-4
AUROC (95%CI)	0.64 (0.58-0.70)	0.72 (0.65-0.78)
Euclidian cut-off values	≥ 1.51	≥ 1.76
Sensitivity/specificity (%)	62.00/62.84	68.60/71.68
PPV/NPV (%)	13.57/94.62	16.21/96.62
Positive/negative LR	1.67/0.60	2.42/0.44
Correctly classified (%)	62.77	71.45
Comparison of AUROC¹
Based-prognostic scores vs based-prognostic scores plus ALBI	0.003^a	0.002^a
Based-prognostic scores plus ALBI vs ALBI	0.193	0.152
ALBI vs FIB-4	0.033^a	0.004^a

^aP < 0.05.

¹P value by DeLong test.

AUROC: Area under the receiver operating characteristic curve; ALBI: Albumin-bilirubin; LR: Likelihood ratio; NPV: Negative predictive value; PPV: Positive predictive value; FIB-4: Fibrosis-4; CI: Confidence interval.

Full Size Table

Citation: 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
URL: https://www.wjgnet.com/1007-9327/full/v31/i37/110829.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i37.110829