Albumin-bilirubin score reflects the extent of liver fibrosis in chronic hepatitis C patients treated with direct-acting antivirals

Table 1 Baseline demographic data in relation to patients’ fibrosis degree, n (%)/median ± interquartile range

	Non-advanced 118 (51)	Advanced 113 (49)	P value1
Age	51 ± 21	61 ± 25	< 0.001
Gender
Male	54	44	0.29
Female	64	69
Diabetes mellitus
No	95 (56.89)	72 (43.11)	0.003
Yes	23 (35.94)	41 (64.06)
Hypertension
No	91 (56.88)	69 (43.12)	0.06
Yes	27 (38.03)	44 (61.97)
Dyslipidemia
No	116 (98.3)	2 (1.7)	0.32
Yes	109 (96.5)	4 (3.5)
Treatment status
Nonresponder	12 (40)	18 (60)	0.58
Naive	101 (52.6)	91 (47.4)
Relapsed	3 (50)	3 (50)
Intolerant to interferon-based treatment	2 (66.6)	1 (33.3)
Sustained virological response 12
Yes	116 (52)	107 (48)	0.12
No	2 (25)	6 (75)
Medication
Harvoni (ledipasvir/sofosbuvir)	25 (58.1)	18 (41.9)	0.41
Viekirax (ombitasvir/paritaprevir/ritonavir) + ribavirin	5 (35.7)	9 (64.3)
Harvoni (ledipasvir/sofosbuvir) + ribavirin	61 (47.3)	68 (52.7)
Olysio (simeprievir + sofosbuovir)	17 (68)	8 (32)
Zepatier (elbasvir/grazoprevir)	7 (46.2)	6 (53.8)
Viekirax (ombitasvir/paritaprevir/ritonavir)	1 (50)	1 (50)
Viekirax + exviera (dasabuvir)	1 (33.3)	2 (66.6)
Mavyret (glecaprevir/pibrentasvir)	1 (100)	0 (0)
Epclusa (sofosbuvir-velpatasvir)	0 (0)	1 (100)
AFP	4.56 ± 5	6.38 ± 5	< 0.004
ALBI	-2.72 ± 0.45	-2.29 ± 0.60	< 0.001
Albumin	39.5 ± 6.5	35 ± 6.4	< 0.001
ALP	79 ± 30.5	96 ± 45	< 0.003
ALT	33 ± 38	51 ± 57	< 0.001
APRI score	0.43 ± 0.05	1.06 ± 0.1	< 0.001
AST	28 ± 19	51 ± 46	< 0.001
AST/ALT	0.80 ± 0.48	0.95 ± 0.50	< 0.005
FIB-4 score	0.98 ± 0.54	2.3 ± 2.6	< 0.001
Hemoglobin	13.6 ± 2.6	13.7 ± 2.3	0.26
INR	1.0 ± 0.1	1.10 ± 0.20	< 0.001
Platelets	249 ± 113	192 ± 110	< 0.001
Total bilirubin	8.77 ± 7	11.4 ± 9.4	0.05
WBC	5.96 ± 2.54	5.86 ± 2.34	0.17
ALBI grade
Grade I	77 (72.6)	29 (27.4)	< 0.001
Grade II	38 (33.3)	76 (66.6)
Grade III	3 (27.3)	8 (72.7)
FibroScan stages
F0	50 (100)	0 (0)	< 0.001
F1	39 (100)	0 (0)
F2	29 (100)	0 (0)
F3	0 (0)	24 (100)
F4	0 (0)	89 (100)

¹Continuous variables were compared with Mann-Whitney U test and categorical variables were compared with χ² test or Fisher’s exact test.

AFP: Alpha fetoprotein; ALBI: Albumin-bilirubin; ALP: Alkaline phosphatase; ALT: Alanine transaminase; APRI: Aspartate aminotransferase to platelet ratio index; AST: Aspartate transaminase; FIB-4: Fibrosis-4 Index; INR: International normalized ratio; WBC: White blood count.

Table 2 Patients’ laboratory profile, including albumin-bilirubin score, before and after direct-acting antiviral treatment, median ± interquartile range

	Pre-treatment median	Post-treatment	Statistical value	P value1
AFP	5.38 ± 5.00	5.3 ± 4.0	-3.3	0.001
ALBI	-2.51 ± 0.65	-2.62 ± 0.62	-3.77	< 0.001
Albumin2	36.77 ± 5.36	37.66 ± 5.60	-3	< 0.001
ALP	88.5 ± 42.5	78 ± 32	-4.7	< 0.001
ALT	46.5 ± 49.0	18 ± 13	-12.27	< 0.001
AST	37.5 ± 32.0	21 ± 11	-11.34	< 0.001
Hemoglobin	13.65 ± 2.3	13.3 ± 2.8	-3.5	< 0.001
INR	1.10 ± 0.10	1.1 ± 0.2	-1.5	0.132
Platelets2	231.68 ± 88.75	232.65 ± 85.38	-1.4	0.153
Total bilirubin	10.7 ± 7.8	9.1 ± 7.3	-0.298	0.760
WBC	5.91 ± 2.39	6.13 ± 2.99	-2.9	0.003

¹Wilcoxon signed ranks test.

²Presented as mean ± SD and were compared with paired t-test.

AFP: Alpha fetoprotein; ALBI: Albumin-bilirubin; ALP: Alkaline phosphatase; ALT: Alanine transaminase; INR: International normalized ratio; WBC: White blood count.

Table 3 Albumin-bilirubin scores before and after direct-acting antiviral treatment in relation to the degree of liver fibrosis

Fibrosis		n	Median	Interquartile range	Minimum	Maximum	Statistical value	P value1
Non-advanced fibrosis	ALBI	118	-2.73	0.43	-3.65	0.58	-1.9	0.05
	ALBI2	118	-2.81	0.46	-3.78	-0.50
Advanced fibrosis	ALBI	112	-2.26	0.65	-3.26	0.72	-3.4	< 0.05
	ALBI2	113	-2.41	0.67	-3.45	-0.64

¹Wilcoxon Signed Ranks Test.

²After treatment with direct-acting antiviral agents.

ALBI: Albumin-bilirubin.

Table 4 Correlation of albumin-bilirubin score with other non-invasive tests for liver fibrosis

			APRI score	AST to ALT	FIB-4 index
ALBI	Baseline	Spearman’s rank correlation coefficient	0.435b	0.299b	0.543b
		P value	0.000	0.000	0.000
	After DAA	Spearman’s rank correlation coefficient	0.190b	0.211b	0.154a
		P value	0.004	0.001	0.019

^aP < 0.05, correlation is significant (2-tailed).

^bP < 0.01, correlation is significant (2-tailed).

ALBI: Albumin-bilirubin; DAA: Direct-acting antiviral agents; APRI: Aspartate aminotransferase to platelet ratio index; ALT: Alanine transaminase; AST: Aspartate transaminase; FIB-4: Fibrosis-4 index.

Table 5 Albumin-bilirubin score’s discriminatory power in comparison with other non-invasive tests for liver fibrosis

	ALBI	APRI score	AST to ALT	FIB-4 index
AUC	0.76	0.76	0.60	0.80
P value	< 0.001	< 0.001	0.005	< 0.001
Sensitivity (%)	60	59	54	65
Specificity (%)	83	83	64	84
95%CI	0.70-0.81	0.699-0.82	0.535-0.681	0.76-0.87

AUC: Area under the curve; CI: Confidence interval; ALBI: Albumin-bilirubin; APRI: Aspartate aminotransferase to platelet ratio index; AST: Aspartate transaminase; ALT: Alanine transaminase; FIB-4: Fibrosis-4 index.

Table 6 Multivariate linear regression analysis of albumin-bilirubin score and other non-invasive tests for predicting liver fibrosis

Model	Unstandardized coefficients B	SE	Standardized coefficients beta	t	P value	95%CI
Constant	1.788	0.180		9.911	< 0.001	1.433-2.144
ALBI	0.212	0.054	0.257	3.936	< 0.001	0.106-0.318
AST to ALT	0.103	0.094	0.069	1.092	0.276	-0.083 to 0.288
APRI score	0.136	0.044	0.229	3.077	0.002	0.049-0.222
FIB-4 index	0.007	0.012	0.045	0.610	0.543	-0.017 to 0.031

ALBI: Albumin-bilirubin; AST: Aspartate transaminase; ALT: Alanine transaminase; APRI: Aspartate aminotransferase to platelet ratio index; FIB-4: Fibrosis-4 index.