Review

The ALBI score: From liver function in patients with HCC to a
general measure of liver function
Hidenori Toyoda,1,* Philip J. Johnson2

Summary
The (albumin-bilirubin) ‘ALBI’ score is an index of ‘liver function’ that was recently developed toassess prognosis in patients with hepatocellular carcinoma, irrespective of the degree of underlying
liver ﬁbrosis. Other measures of liver function, such as model for end-stage liver disease (MELD) andChild-Pugh score, which were introduced for speciﬁc clinical scenarios, have seen their use
extended to other areas of hepatology. In the case of ALBI, its application has been increasingly
extended to chronic liver disease in general and in some instances to non-liver diseases where it has
proven remarkably accurate in terms of prognosis. With respect to chronic liver disease, numerous
publications have shown that ALBI is highly prognostic in patients with all types and stages ofchronic liver disease. Outside of liver disease, ALBI has been reported as being of prognostic value inconditions ranging from chronic heart failure to brain tumours. Whilst in several of these reports,
explanations for the relationship of liver function to a clinical condition have been proposed, it has
to be acknowledged that the speciﬁcity of ALBI for liver function has not been clearly demonstrated.
Nonetheless, and similar to the MELD and Child-Pugh scores, the lack of any mechanistic basis for
ALBI’s clinical utility does not preclude it from being clinically useful in certain situations. Why
albumin and bilirubin levels, or a combination thereof, are prognostic in so many different diseases
should be studied in the future.
© 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of theLiver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

Introduction
The albumin-bilirubin (ALBI) score/grade wasoriginally developed as a measure of liver function
in patients with hepatocellular carcinoma (HCC).1 It
was developed by putting all 5 of the originalcomponents of the Child-Pugh score into a multivariable model. The clinical features (ascites, encephalopathy and international normalised ratio)
were shown to be redundant in that the entire
prognostic value of the Child-Pugh score could be
explained by just the albumin and bilirubin levels
in an appropriate formulation derived from themultivariable model, i.e. the ‘Albumin-Bilirubin or
ALBI score’. Furthermore, a review of the literature
revealed more than 30 versions of the Child-Pughscore such that consistent scoring was difﬁcult toachieve.2 To this extent, the ALBI score is a simply‘reﬁned’ version of the Child-Pugh score that excludes redundant features thereby and avoids theinconsistencies inherent in the Child-Pugh grading.
The ALBI ‘grade’, categorised on the basis of the‘ALBI ‘score’ (from 1-3, 1 being best, 3 being theworst), was shown to be at least comparable withthe conventional Child-Pugh score (Child-Pughscore) in terms of its prognostic ability both overall
and for different disease stages and treatments.
The fact that ALBI is calculated on the basis of just 2

objective laboratory values (albumin and bilirubin),without the requirement for subjective assessmentof the extent of ascites or encephalopathy that isnecessary for the Child-Pugh score, is also an
important advantage. The granularity of the ALBIscore permitted the detection of the small changes
in liver function in patients with compensatedcirrhosis that the Child-Pugh score was not sensitive enough to detect. This is particularly importantin an era when the liver function of patients with
HCC has been steadily improving,2,3 so that mostpatients with HCC have no liver (dys)function according to Child-Pugh score.2
The prognostic value of ALBI for all HCC treatments, including hepatic resection,4–20 locoregional ablative therapies,21–26 transarterial,27–37
and systemic therapies38–59 has been extensively
reported and summarised by Demirtas et al. in this
Journal60 and in systematic reviews and a metaanalysis.61,62 As with the Child-Pugh and model for
end-stage liver disease (MELD) scores, both ofwhich were introduced for speciﬁc clinical situations and then extended to more general applications, the same has happened with ALBI.
Increasingly, ALBI is being applied as a preferredmeasure of liver function due to its objectivity andsensitivity for minor liver function deterioration,

Keywords: liver function;
liver ﬁbrosis; hepatocellular
carcinoma; liver-related diseases; non-liver-related diseases; prognosis
Received 25 May 2022;
received in revised form 21
July 2022; accepted 22 July
2022; available online 18
August 20221
Department of
Gastroenterology, Ogaki
Municipal Hospital, Ogaki,
Japan; 2Department of
Molecular and Clinical Cancer
Medicine, University ofLiverpool, Liverpool, UK* Corresponding author.
Address: Department of
Gastroenterology, Ogaki
Municipal Hospital, 4-86
Minaminokawa, Ogaki, Gifu
503-8502, Japan.
E-mail address: hmtoyoda@
spice.ocn.ne.jp (H. Toyoda).

Review
across several areas of medical practice and hepatology. In thisreview, we outline the use of ALBI score/grade across different
specialties including general hepatology and beyond.

Key points

 ALBI score/grade is a liver function measure which was originallydeveloped as a prognostic factor for patients with HCC, and has since
become well established.

Beyond HCC: Application of the ALBI score/grade in
general hepatological practice
The ALBI score/grade has been successfully applied to the prediction of survival in patients with non-malignant liver diseasesof various aetiologies, including chronic viral hepatitis B,63–66
C,67 primary biliary cholangitis68–70 and autoimmune hepatitis71 (Table 1). This is not surprising as liver function is an
important indicator of the progression of liver disease, reﬂecting
how near the patient is towards liver failure and liver-related
mortality (Fig. 1).
In comparison to the MELD score which, by deﬁnition, relates
to ‘end-stage liver disease’, ALBI is sufﬁciently sensitive to detect
the early deterioration of liver function (Fig. 1). Thus, ALBI might
be expected to predict longer-term mortality in patients withcirrhosis72–74 better than the MELD score, which would be expected to predict shorter-term mortality in patients withdecompensated cirrhosis or liver failure. However, several, but
not all, studies reported that ALBI is comparable to MELD for
predicting short-term mortality in patients with decompensatedcirrhosis.66,75–77 Perhaps surprisingly, it has been reported that
ALBI predicts outcomes for patients undergoing liver transplantation.78–80 The initial ALBI report showed no difference insurvival according to pre-transplant ALBI, implying that prognosis was attributable to the function of the new liver. It is
possible that, in those studies citing an association between ALBI
and post-transplant survival, ALBI was acting as a measure ofgeneral peri-operative ill health. The ALBI score is strongly
associated with the degree of hepatic ﬁbrosis, as assessed by the
FIB-4 (ﬁbrosis-4) index81,82 or aspartate aminotransferase-to- ALBI score is objective and can detect smaller changes in liver
dysfunction than the Child-Pugh or MELD scores.

 The ALBI score/grade has been successfully applied to the prediction ofsurvival in patients with non-malignant liver diseases of various
aetiologies.

 ALBI is often used as a standard measure of liver function whenassessing other putative liver function indicators or assessing thechanging degree of liver (dys)function.

 The ALBI score/grade can reportedly be a prognostic factor for several
non-liver-related malignant and non-malignant diseases, the mechanism of which should be clariﬁed in future studies.

platelet ratio index (APRI).83 This observation presumably explains several reports that the ALBI score is an important risk
factor for HCC development,67,74–88 particularly after sustained
virologic response.86–88 The best documented risk score for HCC
in patients with chronic liver disease is the aMAP score89,90
which combines ALBI with age, male sex and platelet countand may form the basis of a realistic risk stratiﬁcation strategy.
In addition to HCC, ALBI has been reported to predict various
complications associated with liver diseases, including portal
hypertension,73 oesophagogastric varices,91,92 or portopulmonary hypertension.93 These can be understood in the context that
ALBI reﬂects liver function and liver disease progression.
ALBI is often used as a standard measure of liver function
when assessing other putative liver function indicators orassessing the changing degree of liver (dys)function (Table 2). In
the area of radiology, the enhancement effects of liver images

Table 1. Studies on ALBI as a prognostic factor in non-HCC patients with liver diseases.
Aetiology

Subject

Main ﬁndings

806

HBV

Cirrhosis

Retrospective

398

HBV

Cirrhosis

Retrospective

81

HBV

Chen et al.66

Retrospective

84

HBV

Decompensatedcirrhosis
ACLF

ALBI score predicted long-term prognosis more accurately than MELD score or Child-Pugh class.
ALBI score predicted long-term prognosis superior to
MELD and MELD-Na score.
ALBI and MELD scores predicted 1-month mortality.

77

Retrospective

100

HBV

ACLF

Fujita et al.67
Chan et al.68

Retrospective
Retrospective

382
61

HCV
PBC

All HCVAll PBC

Fujita et al.69

Retrospective

181

PBC

All PBC

Ito et al.70

Retrospective

409

PBC

All PBCSong et al.71

Retrospective

149

AIH

Cirrhosis

Fragaki et al.72

Retrospective

195

VariousCirrhosis

Study design

Patients

Prediction of mortality/survival
Chen et al.63
Retrospective

Authors

Wang et al.64
Qi et al.

65

Peng et al.

ALBI and MELD scores were independent predictors of
3-month mortality.
Child-Pugh class, ALBI and MELD scores were ineffective
in predicting the in-hospital mortality.
ALBI score predicted overall survival.
ALBI score was the best for predicting liver-related
events among Child-Pugh score, MELD score, Mayo risk
score,
Yale, European, and Newcastle model. ALBI grade stratiﬁed survivals.
ALBI score differentiated liver transplant-free survival
better than APRI.
ALBI score/grade and the Mayo score were superior
prognostic tools among other prognostic tools.
ALBI predicted 6, 12, 24, and 36-month mortality moreaccurately than Child-Pugh scores and MELD score. ALBI
grade 3 showed lower survival than ALBI grade 1 or 2.
ALBI score might be a better prognostic indicator ofmortality than Child-Pugh score, MELD and MELD-Na
scores.
(continued on next page)

JHEP Reports 2022 vol. 4 j 100557

2

Table 1 (continued)
Authors

Study design

Patients

Aetiology

Subject

Main ﬁndings

Hsieh et al.73

Retrospective

242

VariousCirrhosis

Zou et al.74

Retrospective

631

VariousCirrhosis

Oikonomou et al.75

Prospective

325

VariousDecompensated cirrhosis

Wan et al.76

Retrospective

456

VariousDecompensated cirrhosis

Bernardi et al.78

Retrospective

301

VariousTransplantation

Zhang et al.79

Retrospective

272

Various

Living-donor transplantation

Ma et al.80

Retrospective

258

Various

Cadaveric transplantation

ALBI score was associated with short-term outcome.
ALBI was an independent predictor of survival as well as
MELD, HVPG, and serum sodium.
The prognostic performance of ALBI score was comparable with that of the Child-Pugh and MELD scores forpredicting the in-hospital mortality of acute uppergastrointestinal bleeding in liver cirrhosis.
ALBI was associated with survival or complications
better than Child-Pugh class and MELD score.
ALBI score provided a reliable prediction of mortality as
well as Child-Pugh score, MELD score, MELD-Na score,and iMELD score.
ALBI grade 3 was related to lower survival after livertransplantation.
ALBI score, Child-Pugh score, and MELD score predicted30-day mortality with complications.
The ALBI score predicted overall survival and postoperative complications after liver transplantation.

Prediction of the development of HCC
Retrospective
Fujita et al.84

91

HBV

All HBV

Fujita et al.67
Casadei Gardini et al.85

Retrospective
Retrospective

382
514

HCV
HCV

All HCVAll HCV, after DAAs

Abe et al.86

Retrospective

188

HCV

Cirrhosis, after SVR

Tanaka et al.87

Retrospective

2,911

HCV

Cirrhosis, after SVR

88

Retrospective

575

HCV

Cirrhosis, after SVR

Caviglia et al.

Prediction of liver-related complications other than HCC
Retrospective
242
Various
Hsieh et al.73

Cirrhosis

Miyamoto et al.91

Retrospective

141

VariousCirrhosis

Chen et al.92

Retrospective

1,102

VariousCirrhosis and HCC

Kawaguchi et al.93

Retrospective

883

VariousCirrhosis

ALBI scores < -2.190 correlated with better HCC-freesurvival.
Smaller ALBI scores predict better HCC-free survival.
ALBI
score,
plateletcountandaspartateaminotransferase-lymphocyte ratio identiﬁed patientswith higher risk of HCC.
ALBI score, platelet count, and diabetes were associatedwith HCC occurrence after SVR.
ALBI grades 2 or 3 was associated with higher HCC risk
as well as higher age and serum AFP levels.
Only the ALBI score signiﬁcantly associated with de novo
HCC development among Forns index, APRI, FIB-4, andaMAP.
ALBI score is best correlated with hepatic venous pressure gradient.
ALBI grade may be useful in predicting the presence ofgastroesophageal varices and for stratifying bleedingrisk.
Combination of ALBI grade and platelet counts predicted
a presence of high-risk oesophageal varices and variceal
haemorrhage.
ALBI score was the most impacted factor associated withsevere portopulmonary hypertension.

ALBI, albumin-bilirubin; APRI, aspartate aminotransferase-to-platelet ratio index; DAA, direct-acting antiviral; FIB-4, ﬁbrosis-4; HCC, hepatocellular carcinoma; MELD, modelfor end-stage liver disease; PBC, primary biliary cholangitis; SVR, sustained virological response.

(i.e. uptake of contrast materials by the liver) on contrastenhanced CT or MRI, are reportedly inﬂuenced by liver function as measured by ALBI.94–96 Other studies have reported theeffect of liver function, as assessed by ALBI, on serum levels of
tumour markers, such as CA-125,97 and the frequency of muscle
cramps in patients with cirrhosis.98 Several pharmacokinetic
studies have assessed the role of liver dysfunction in relation to
drug-induced adverse events.99–101
Although ALBI is widely used according to grade, the score on
which ‘grade’ is based is, in fact, a continuous variable and, assuch, is particularly appropriate for assessment of changes in liverfunction over time. Thus, changes in ALBI score have been reported during the progression of liver disease to cirrhosis and todecompensation,99,100 during the course of systemic therapy for
HCC, and in response to viral suppression by antiviral therapy orother therapies for liver diseases. In patients with HCC who had
undergone systemic therapy, the adverse effect of moleculartargeted drugs or immune checkpoint inhibitors on liverfunction was often evaluated based on changes in ALBIscore.102–107 Conversely, the restoration of liver function in association with viral eradication or suppression – by nucleot(s)ide
analogues for HBV or interferon- or direct-acting antiviral-based
therapy for HCV – has been characterised by a decrease in ALBIscore.108–111 Further, the improvement of liver function associatedwith balloon-occluded retrograde transvenous obliteration for
gastric varices or administration of rifaximin to control hyperammonaemia have been analysed with the ALBI score.112,113

Beyond liver diseases – ALBI in non-hepatic tumours
Since the original publication, there have been reports of a strong
association between ALBI and mortality in many nonhepatological conditions (Table 3). For example, ALBI has beenshown to be prognostic in cancers other than HCC, including
pancreatic, colon and gastric cancer, intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, and even brain

JHEP Reports 2022 vol. 4 j 100557

3

Review
HCC
Cirrhosis
Child-Pugh Child-Pugh Child-Pughclass A
class B
class C
Death
FIB-4 index
Renal failure
JaundiceEncephalopathy
Ascites
ALBI score

MELD score

Liver disease progression

Treatment of HCC

Acute liver injury
Viral suppression by antiviral therapy

Fig. 1. Schematic representation of the changes of ALBI score in comparison to FIB-4 index and MELD score, in association with the progression of liverdiseases to end-stage liver disease. ALBI score increases earlier than MELD score and before the development of cirrhosis, revealing slight deterioration in liverfunction. Liver function deteriorates with the treatment of HCC and may be restored by the eradication or suppression of viral hepatitis. ALBI, albumin-bilirubin;
FIB-4, ﬁbrosis-4; HCC, hepatocellular carcinoma; MELD, model for end-stage liver disease.

cancer (glioma and medulloblastoma).114–136 ALBI is likely to be
reﬂective of liver dysfunction in patients undergoing hepatic
resection for intrahepatic tumours, such as intrahepatic cholangiocarcinoma or metastatic liver tumours, and tolerance forthose undergoing systemic therapy, including chemotherapies,
molecular-targeted drugs and immune checkpoint inhibitors.118,123,126-128,131,133,134 Although most authors haveattempted to link the association of ALBI with a particular cancer
to liver function, we should consider whether its association
with mortality is actually through some aspect of liver
dysfunction or whether it simply reﬂects the prognostic power ofserum albumin and bilirubin levels, independent of liver function. The mechanism underlying the prognostic impact of albumin and bilirubin remains unknown, but authors of theaforementioned studies have discussed the role of albumin as anindicator of malnutrition, and the immunomodulatory roles ofboth albumin and bilirubin. Further supporting the relative nonspeciﬁcity of ALBI is its role in predicting very short-term mortality of patients with all malignancies in terminal care.137

Beyond liver diseases – ALBI in benign non-liverdiseaseThere have been several reports that the ALBI score is prognostic
in certain non-hepatological conditions including acute or
chronic heart failure (short-term and long-term prognosis),138–143 acute pancreatitis144 and aortic dissection. In someconditions the prognostic value is remarkably high. For example,

in acute pancreatitis145 ALBI proved superior to well-establishedscores such as SOFA (sequential organ failure assessment), SAPS
(simpliﬁed acute physiology score)-II, APACHE (acute physiology
and chronic health evaluation)-II, Ranson and Glasgow. In each ofthese instances authors have attempted to explain their resultsin terms of liver dysfunction associated with the particularcondition described. For example, in the case of cardiac failure,several authors have noted that elevated bilirubin, hypoalbuminaemia, and hepatic ﬁbrosis often accompany advanced
heart failure due to severe passive congestion.138 Whilst such
explanations may be valid, it is important to acknowledge, as in
the case of non-hepatological cancer, that these observations
may cast doubt on the speciﬁcity of ALBI for liver function.
However, such an observation does not decrease the value of
ALBI in routine hepatological practice. The Child-Pugh score, of
which ALBI is just a ‘reﬁnement’, has never been shown to be
speciﬁc for liver disease and yet it has been widely used, with
beneﬁt, for more than 40 years. However, there is considerable
literature on the association of disturbances in both albumin andbilirubin metabolism with many chronic conditions. Such issues
are worthy of further research and it is likely that, in different
clinical conditions, different combinations of albumin and bilirubin, and perhaps other parameters, might prove to be optimal.

Conclusion and future perspectives
Severe deterioration of liver function causes serious morbidity
irrespective of its origin. It is therefore not surprising that ALBI, a

JHEP Reports 2022 vol. 4 j 100557

4

Table 2. ALBI used as a measure of liver function.
Subject

Main ﬁndings

303

Dual-energy CT images

Retrospective

220

Takatsu et al.96

Retrospective

212

Hepatobiliary phaseenhancement by EOB-MRI
Hepatobiliary phaseenhancement by EOB-MRI

Edula et al.97

Retrospective

172

Tumour marker

Shimada et al.98

Retrospective

70

Muscle cramp

Comparison of hepatic extracellular volume fractions
between liver segments based on ALBI grade.
Quantitative liver-spleen contrast ratio was correlated
better by ALBI grade than by Child-Pugh score.
Quantitative liver-spleen contrast ratio and ALBI grade
could predict the liver contrast enhancement effect inhepatobiliary phase images of EOB-MRI.
CA-125 concentration in cirrhotic patients based on liverfunction assessed by ALBI score, MELD score, and ChildPugh class.
Muscle cramp was observed more frequently in association of the deterioration of liver function assessed by
ALBI score or Child-Pugh class.

Authors

Study design

Used as a standard measure of liver function
Retrospective
Ozaki et al.94
Takatsu et al.95

Patients

Liver function by ALBI and pharmacokinetics
Shimizu et al.99

Retrospective

183

Serum drug concentrations

Kokubun et al.100

Retrospective

25

Drug-induced adverse event

Asai et al.101

Retrospective

109

Drug-induced liver injury

ALBI score could be used to assess variations in theserum concentration of methadone.
ALBI score was signiﬁcantly correlated with the incidence of ifosfamide-related neuropsychiatric symptoms.
Low liver function assessed by ALBI was predictor for
micafungin-induced liver injury.

Serial changes in liver function assessed by ALBI
Guha et al.102

Retrospective

379

Liver disease progression

Sakamaki et al.103

Retrospective
and prospective

159

Liver disease progression

Johnson et al.108

Retrospective

2,394

Nakajima et al.109

Retrospective

403

Ogawa et al.110

Retrospective

392

Tada et al.111

Prospective

65

Waguri et al.

Retrospective

57

Ishikawa et al.113

112

Retrospective

21

104

Kudo et al.

Retrospective

534

Vogel et al.105

Retrospective

413

Muto et al.106

Retrospective

237

Hiraoka et al.107

Retrospective

123

Liver function after SVR in
HCVLiver function after SVR in
HCVLiver function after SVR in
HCV cirrhosis
Liver function after SVR in
HCV decompensated cirrhosis
Liver function after B-RTO
Liver function after treatment
for encephalopathy
Liver function by
ramucirumab for HCC
Liver function by
pembrolizumab for HCC
Liver function bymolecular-targeted
therapy for HCC
Liver function bylenvatinib for HCC

A scoring system, based on a combination of ALBI scoreand FIB-4 index, that identiﬁes patients at risk for liver
decompensation.
A longitudinal increase in the ALBI score is closely
associated with non-malignancy-related mortality andquality of life.
ALBI score decreased in SVR and increased in non-SVR inboth IFN- and DAAs-treated patients.
ALBI grade decreased by SVR by DAA even in elderly
patients.
FIB-4 index and ALBI score signiﬁcantly decreased after
SVR.
ALBI scores decreased during and after treatment inpatients who achieved SVR.
ALBI scores and Child-Pugh class signiﬁcantly decreased
3 years after B-RTO.
ALBI scores and CONUT score signiﬁcantly decreased
after rifaximin administration.
Ramucirumab for HCC did not negatively impact liverfunction assessed by ALBI grade.
Pembrolizumab did not adversely impact liver function
assessed by ALBI grade.
Transient deterioration of liver function assessed by ALBI
associated with sorafenib or lenvatinib.
Decline in hepatic function assessed by ALBI was common in the early stage after introducing lenvatinib.

ALBI, albumin-bilirubin; B-RTO, balloon-occluded retrograde transvenous obliteration; DAA, direct-acting antiviral; EOB-MRI, ethoxybenzyl-MRI; FIB-4, ﬁbrosis-4; HCC, hepatocellular carcinoma; IFN, interferon; SVR, sustained virological response.

measure of liver function, can be a prognostic factor for diseases
other than those of the liver. The Child-Pugh score has been used
for a long time as a measure of liver (dys)function in patientswith cirrhosis, predominantly by hepatologists to assess theseverity of cirrhosis. In contrast, shortly after its originaldescription, ALBI has been being widely used by healthcare
specialists, this is perhaps due to its objectivity and simplicity.
The severe liver dysfunction in patients with cirrhosis (i.e., rightpart of Fig. 1) is the area mainly dealt with by hepatologists. It is
likely therefore that the Child-Pugh or MELD scores will continue
to be used by hepatologists. In contrast, in many patients who do
not have primary liver disease but may have modest liver
dysfunction (i.e., middle or left parts of Fig. 1), the ALBI score canbe used by non-hepatologists. Studies on the speciﬁcity of ALBI
for liver function will be an interesting research area in the
future.

JHEP Reports 2022 vol. 4 j 100557

5

Review
Table 3. Studies on ALBI as a prognostic factor in patients with non-liver-related diseases.
Subject

Main ﬁndings

535

Intrahepaticcholangiocarcinoma

Retrospective

706

Yang et al.116

Retrospective

52

Intrahepaticcholangiocarcinoma
Intrahepaticcholangiocarcinoma

Ni et al.117

Retrospective

78

Intrahepaticcholangiocarcinoma

Deng et al.118

Retrospective

42

Intrahepaticcholangiocarcinoma

Wang et al.119

Retrospective

109

Extrahepaticcholangiocarcinoma

Fernandez-Placencia
et al.120
Imamura et al.121

Retrospective

101

Retrospective

877

Ampullary of Vater
cancerPancreatic cancer

Yagyu et al.122

Retrospective

100

Pancreatic cancer

Sakin et al.123

Retrospective

273

Pancreatic cancer withliver metastasis

Zhang et al.124

Retrospective

269

Advanced
cancerKoh et al.125

Retrospective

1,015

Colorectal cancer

Watanabe et al.126

Retrospective

60

Colorectal cancer withmetastasis

Pereyra et al.127

Retrospective

339

Colorectal cancer withliver metastasis

Abdel-Rahman et al.128

Retrospective

1,434

Colorectal cancer withliver metastasis

Zhu et al.129

Retrospective

243

Gastric cancer

Kanda et al.130

Retrospective

283

Gastric cancer

Miwa et al.131

Retrospective

98

Gastric cancer

Kinoshita et al.132

Retrospective

947

Non-small cell lungcancerMatsukane et al.133

Retrospective

140

Non-small cell lungcancerTakada et al.134

Retrospective452

Non-small cell lungcancerZhang et al.135

Retrospective324

High-grade glioma

Zhu et al.136

Retrospective

111

Medulloblastoma

ALBI grade with prognostic nutritional index is apredictor for overall survival and progression-freesurvival after radical resection.
ALBI score was associated with both short- and longterm mortalities following resection.
ALBI grade was a signiﬁcant biomarker for predicting
survival in patients within the Milan criteria who
underwent microwave ablation.
ALBI grade was effective to predict long-term survivals of patients treated with CT-guided microwave
ablation.
The median overall survival of patients with ALBI
grade 1 was longer than that of patients with ALBI
grade 2 treated with PD-1-targeted immunotherapy.
ALBI grade could be used as a predictor of survival inpatients who underwent biliary stenting combinedwith iodine-125 seed implantation.
ALBI grade and eGFR were predictors of mortality
after pancreaticoduodenectomy.
ALBI grade was a predictor for overall survival inpatients who underwent pancreatectomy.
The combination of ALBI grade and CA19-9 concentration predicted overall survival.
ALBI grade was related to overall survival andprogression-free survival in patients with liver
metastasis treated with a ﬁrst-line chemotherapy.
ALBI score was correlated with overall survival inpatients with liver metastasis but not in patients
without liver metastasis.
ALBI score was an independent factor associatedwith overall survival and further discriminated survival in combination with myosteatosis.
ALBI score was signiﬁcantly correlated with overall
survival in patients receiving later-line chemotherapy with regorafenib.
ALBI with APRI predicted liver dysfunction associated with neoadjuvant chemotherapy and postoperative mortality.
Higher baseline ALBI score is associated with worse
overall and progression-free survival in patients treatedwith ﬁrst-line systemic therapy (panitumumab).
ALBI grade could predict postoperative complications and overall survival, especially those with TNM
stages II-III.
ALBI grade was a predictive factor for disease-freeand disease-speciﬁc survival in patients with pT2-4
cancer after radical gastrectomy.
ALBI was associated with the tolerability of postoperative adjuvant S-1 monotherapy in patientswith pStage II/III cancer.
ALBI grade 2/3 was an independent predictor ofworse cancer-speciﬁc survival in patients who underwent resection.
ALBI grade was an independent prognostic factor forboth progression-free survival and overall survival
who received immune checkpoint inhibitors.
The ALBI grade was an independent prognostic factor for survival in patients with advanced or recurrent cancer who receive anti-PD-1-based therapy.
ALBI score was independent predictor for bothprogression-free survival and overall survival in patients who received resection.
ALBI score was a prognostic biomarker for overall
survival in patients undergoing surgical resection as
well as systemic immune-inﬂammation index andprognostic nutritional index.

Authors

Study design

Patients

Li et al.114

Retrospective

Tsilimigras et al.115

Cancer other than HCC

pancreatic(continued on next page)

JHEP Reports 2022 vol. 4 j 100557

6

Table 3 (continued)
Subject

Main ﬁndings

Terminal cancer

ALBI as well as CRP/albumin, prognostic nutritional
index, FIB-4 and their combinations helped identify
cancer patients who have a life expectancy less than
2 weeks.

3,381Heart failure

Retrospective

180

Heart failure

Han et al.140

Retrospective

9,749

Heart failure

Saito et al.141

Retrospective

274

Heart failure

Matsue et al.142

Retrospective

1,190

Acute heart failure

Kawata et al.143

Retrospective

262

Acute heart failure

Shi et al.144

Retrospective284

Acute pancreatitis

Liu et al.145

Retrospective

812

Aortic dissection

The ALBI score was useful at predicting the mortalityof patients with heart failure requiring ICU
admission.
ALBI score had a predictive value for death fromheart failure in patients who underwent cardiac
resynchronisation therapy.
ALBI score was an independent prognosticator of inhospital mortality.
Higher ALBI score was associated with higher allcause mortality in cardiac resynchronisation therapy recipients.
ALBI score, but not the MELD score excluding prothrombin time was associated with ﬂuid overload
and was associated with 1-year mortality.
ALBI score was independently associated with inhospital mortality in patients hospitalised for acuteheart failure.
ALBI score could be a useful marker of in-hospitalmortality better than SOFA, SAPS II, APACHE II,
Ranson and Glasgow scores.
ALBI score as well as MELD score and APRI was
associated with in-hospital and follow-up mortality
in patients with type B aortic dissection treated withthoracic endovascular aortic repair.

Authors

Study design

Patients

Ieda et al.137

Retrospective483

Luo et al.138

Retrospective

Yamada et al.139

Non-malignant diseases

ALBI, albumin-bilirubin; APACHE, acute physiology and chronic health evaluation; APRI, aspartate aminotransferase-to-platelet ratio index; CRP, C-reactive protein; eGFR,
estimated glomerular ﬁltration rate; ICU, intensive care unit; MELD, model for end-stage liver disease; SAPS, simpliﬁed acute physiology score; SOFA, sequential organ failure
assessment.

Abbreviations
ALBI, albumin-bilirubin; APRI, aspartate aminotransferase-to-platelet ratio index; HCC, hepatocellular carcinoma; MELD, model for end-stage
liver disease.

Financial support
The authors received no ﬁnancial support to produce this manuscript.

Conﬂict of interest
The authors declare that there is no conﬂict of interest on this review.
Please refer to the accompanying ICMJE disclosure forms for further
details.

Authors’ contributions
Concept: Hidenori Toyoda and Philip J. Johnson. Data acquisition: Hidenori Toyoda. Drafting the manuscript: Hidenori Toyoda. Manuscript
editing: Philip J. Johnson. Manuscript approval: Hidenori Toyoda andPhilip J. Johnson.

Supplementary data
Supplementary data to this article can be found online at https://doi.org/1
0.1016/j.jhepr.2022.100557.

References[1] Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL,
et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol
2015;33:550–558.
[2] Johnson P, Pinato DJ, Kalyuzhnyy A, Toyoda H. Breaking the Child-Pughdogma in hepatocellular carcinoma. J Clin Oncol 2022;40:2078–2082.

[3] Kumada T, Toyoda H, Tada T, Yasuda S, Tanaka J. Changes in backgroundliver function in patients with hepatocellular carcinoma over 30 years–comparison of Child-Pugh classiﬁcation and albumin bilirubin grade–.
Liver Cancer 2020;9:518–528.
[4] Wang YY, Zhong JH, Su ZY, Huang JF, Lu SD, Xiang BD, et al. Albumin-bilirubin versus Child-Pugh score as a predictor of outcome
after liver resection for hepatocellular carcinoma. Br J Surg
2016;103:725–734.
[5] Li MX, Zhao H, Bi XY, Li ZY, Huang Z, Han Y, et al. Prognostic value of thealbumin- bilirubin grade in patients with hepatocellular carcinoma:
validation in a Chinese cohort. Hepatol Res 2017;47:731–741.
[6] Ho SY, Liu PH, Hsu CY, Tan K, Zheng D, Du X, et al. Comparison of twelve
liver functional reserve models for outcome prediction in patients with
hepatocellular carcinoma undergoing surgical resection. Sci Rep
2018;8:4773.
[7] Zhao S, Wang M, Yang Z, Tan K, Zheng D, Du X, et al. Comparison between Child-Pugh score and Albumin-Bilirubin grade in the prognosis ofpatients with HCC after liver resection using time-dependent ROC. Ann
Transl Med 2020;8:539.
[8] Ma XL, Zhou JY, Gao XH, Tian L, Wu J, Zhang CY, et al. Application of thealbumin- bilirubin grade for predicting prognosis after curative resection of patients with early-stage hepatocellular carcinoma. Clin Chim
Acta 2016;462:15–22.
[9] Dong ZR, Zou J, Sun D, Shi GM, Ke AW, Cai JB, et al. Preoperative
albumin-bilirubin score for postoperative solitary hepatocellular carcinoma within the Milan criteria and Child-Pugh A cirrhosis. J Cancer
2017;8:3862–3867.
[10] Lee YH, Koh YS, Hur YH, Cho CK, Kim HJ, Park EK. Effectiveness of thealbumin-bilirubin score as a prognostic factor for early recurrence after
curative hepatic resection for hepatocellular carcinoma. Ann Hepatobiliary Pancreat Surg 2018;22:335–343.
[11] Ho SY, Hsu CY, Liu PH, Hsia CY, Su CW, Huang YH, et al. Albumin-bilirubin(ALBI) grade-based nomogram to predict tumor recurrence in

JHEP Reports 2022 vol. 4 j 100557

7

Reviewpatients with hepatocellular carcinoma. Eur J Surg Oncol 2019;45:
776–781.
[12] Xu W, Li R, Liu F. Novel Prognostic Nomograms for predicting early andlate recurrence of hepatocellular carcinoma after curative hepatectomy.
Cancer Manag Res 2020;12:1693–1712.
[13] Wu MY, Qiao Q, Wang K, Ji GW, Cai B, Li XC. Development and validationof pre- and post-operative models to predict recurrence after resectionof solitary hepatocellular carcinoma: a multi-institutional study. Cancer
Manag Res 2020;12:3503–3512.
[14] Lin CY, Lin CC, Wang CC, Chen CL, Hu TH, Hung CH, et al. The ALBI grade
is a good predictive model for very late recurrence in patients with
hepatocellular carcinoma undergoing primary resection. World J Surg
2020;44:247–257.
[15] Cho WR, Hung CH, Chen CH, Lin CC, Wang CC, Liu YW, et al. Ability of the
post-operative ALBI grade to predict the outcomes of hepatocellular
carcinoma after curative surgery. Sci Rep 2020;10:7290.
[16] Ye L, Liang R, Zhang J, Chen C, Chen X, Zhang Y, et al. Postoperative albuminbilirubin grade and albumin-bilirubin change predict the outcomes of hepatocellular carcinoma after hepatectomy. Ann Transl Med 2019;7:367.
[17] Shi JY, Sun LY, Quan B, Xing H, Li C, Liang L, et al. A novel online calculator
based on noninvasive markers (ALBI and APRI) for predicting posthepatectomy liver failure in patients with hepatocellular carcinoma.
Clin Res Hepatol Gastroenterol 2020:101534.
[18] Amisaki M, Uchinaka E, Morimoto M, Tokuyasu N, Sakamoto T, Honjo S,
et al. Post- operative albumin-bilirubin grade predicts long-term outcomes among Child-Pugh grade A patients with hepatocellular carcinoma after curative resection. Hepatobiliary Pancreat Dis Int
2018;17:502–509.
[19] Zou H, Wen Y, Yuan K, Miao XY, Xiong L, Liu KJ. Combining albuminbilirubin score with future liver remnant predicts post-hepatectomy
liver failure in HBV-associated HCC patients. Liver Int 2018;38:494–502.
[20] Fagenson AM, Gleeson EM, Pitt HA, Lau KN. Albumin-bilirubin score vsmodel for end- stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg 2020;230:637–645.
[21] Kornberg A, Witt U, Schernhammer M, Kornberg J, Muller K, Friess H,
et al. The role of preoperative albumin-bilirubin grade for oncologicalrisk stratiﬁcation in liver transplant patients with hepatocellular carcinoma. J Surg Oncol 2019;120:1126–1136.
[22] Tai K, Kuramitsu K, Kido M, Tanaka M, Komatsu S, Awazu M, et al. Impactof albumin-bilirubin score on short- and long-term survival after livingdonor liver transplantation: a retrospective study. Transpl Proc
2020;52:910–919.
[23] Oh IS, Sinn DH, Kang TW, Lee MW, Kang W, Gwak GY, et al. Liver function
assessment using albumin-bilirubin grade for patients with very earlystage hepatocellular carcinoma treated with radiofrequency ablation.
Dig Dis Sci 2017;62:3235–3242.
[24] An C, Li X, Yu X, Cheng Z, Han Z, Liu F, et al. Nomogram based onalbumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation.
Cancer Biol Med 2019;16:797–810.
[25] Chen PC, Chiu NC, Su CW, Huang YH, Hou MC, Lin HC, et al. Albuminbilirubin grade may determine the outcomes of patients with very earlystage hepatocellular carcinoma after radiofrequency ablation therapy.
J Chin Med Assoc 2019;82:2–10.
[26] Kao WY, Su CW, Chiou YY, Chiu NC, Liu CA, Fang KC, et al. Hepatocellular carcinoma: nomograms based on the albumin-bilirubin grade
to assess the outcomes of radiofrequency ablation. Radiology
2017;285:670–680.
[27] Ho SY, Liu PH, Hsu CY, Hsia CY, Lee YH, Lee RC, et al. Prognostic role ofnoninvasive liver reserve markers in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. PLoS One 2017;12:e0180408.
[28] Waked I, Berhane S, Toyoda H, Chan SL, Stern N, Palmer D, et al.
Transarterial chemoembolisation of hepatocellular carcinoma: impact ofliver function and vascular invasion. Br J Cancer 2017;116:448–454.
[29] Lee IC, Hung YW, Liu CA, Lee RC, Su CW, Huo TI, et al. A new ALBIbased model to predict survival after transarterial chemoembolizationfor BCLC stage B hepatocellular carcinoma. Liver Int 2019;39:1704–
1712.
[30] Zhong BY, Ni CF, Ji JS, Yin GW, Chen L, Zhu HD, et al. Nomogram andartiﬁcial neural network for prognostic performance on the albuminbilirubin grade for hepatocellular carcinoma undergoing transarterial
chemoembolization. J Vasc Interv Radiol 2019;30:330–338.
[31] Ni JY, Fang ZT, Sun HL, An C, Huang ZM, Zhang TQ, et al. A nomogram topredict survival of patients with intermediate-stage hepatocellular

carcinoma after transarterial chemoembolization combined with microwave ablation. Eur Radiol 2020;30:2377–2390.
[32] Nam JY, Choe AR, Sinn DH, Lee JH, Kim HY, Yu SJ, et al. A differential risk
assessment and decision model for transarterial chemoembolization in
hepatocellular carcinoma based on hepatic function. BMC Cancer
2020;20:504.
[33] Zhao S, Zhang T, Li H, Wang M, Xu K, Zheng D, et al. Comparison ofalbumin-bilirubin grade versus Child-Pugh score in predicting theoutcome of transarterial chemoembolization for hepatocellular carcinoma using time-dependent ROC. Ann Transl Med 2020;8:538.
[34] Ho SY, Hsu CY, Liu PH, Lee RC, Ko CC, Huang YH, et al. Albumin-bilirubin(ALBI) grade-based nomogram for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Dig Dis Sci
2021;66:1730–1738.
[35] Mohammadi H, Abuodeh Y, Jin W, Frakes J, Friedman M, Biebel B, et al.
Using the albumin-bilirubin (ALBI) grade as a prognostic marker forradioembolization of hepatocellular carcinoma. J Gastrointest Oncol
2018;9:840–846.
[36] Gui B, Weiner AA, Nosher J, Lu SE, Foltz GM, Hasan O, et al. Assessmentof the albumin-bilirubin (ALBI) grade as a prognostic indicator for hepatocellular carcinoma patients treated with radioembolization. Am J
Clin Oncol 2018;41:861–866.
[37] Antkowiak M, Gabr A, Das A, Ali R, Kulik L, Ganger D, et al. Prognostic
role of albumin, bilirubin, and ALBI scores: analysis of 1000 patientswith hepatocellular carcinoma undergoing radioembolization. Cancers(Basel) 2019;11.
[38] Pinato DJ, Yen C, Bettinger D, Ramaswami R, Arizumi T, Ward C, et al. The
albumin- bilirubin grade improves hepatic reserve estimation postsorafenib failure: implications for drug development. Aliment Pharmacol Ther 2017;45:714–722.
[39] King J, Palmer DH, Johnson P, Ross P, Hubner RA, Sumpter K, et al. Sorafenib for the treatment of advanced hepatocellular cancer -a UK audit.
Clin Oncol (R Coll Radiol) 2017;29:256–262.
[40] Lee PC, Chen YT, Chao Y, Huo TI, Li CP, Su CW, et al. Validation of thealbumin-bilirubin grade-based integrated model as a predictor forsorafenib-failed hepatocellular carcinoma. Liver Int 2018;38:321–330.
[41] Abdel-Rahman O. Impact of baseline characteristics on outcomes ofadvanced HCC patients treated with sorafenib: a secondary analysis of aphase III study. J Cancer Res Clin Oncol 2018;144:901–908.
[42] Tada T, Kumada T, Toyoda H, Tsuji K, Hiraoka A, Michitaka K, et al.
Impact of albumin- bilirubin grade on survival in patients with hepatocellular carcinoma who received sorafenib: an analysis using timedependent receiver operating characteristic. J Gastroenterol Hepatol
2019;34:1066–1073.
[43] Rovesti G, Orsi G, Kalliopi A, Vivaldi C, Marisi G, Faloppi L, et al. Impact ofbaseline characteristics on the overall survival of HCC patients treatedwith sorafenib: ten years of experience. Gastrointest Tumors 2019;6:92–
107.
[44] Kuo YH, Wang JH, Hung CH, Rau KM, Wu IP, Chen CH, et al. Albuminbilirubin grade predicts prognosis of HCC patients with sorafenib use.
J Gastroenterol Hepatol 2017;32:1975–1981.
[45] Takada H, Kurosaki M, Tsuchiya K, Komiyama Y, Itakura J, Takahashi Y,
et al. Baseline and early predictors of good patient candidates forsecond-line after sorafenib treatment in unresectable hepatocellular
carcinoma. Cancers (Basel) 2019;11:1256.
[46] Edeline J, Blanc JF, Johnson P, Campillo-Gimenez B, Ross P, Ma YT, et al.
A multicentre comparison between Child Pugh and albumin-bilirubinscores in patients treated with sorafenib for hepatocellular carcinoma.
Liver Int 2016;36:1821–1828.
[47] Vogel A, Frenette C, Sung MW, Daniele B, Baron AD, Chan SL, et al.
Baseline liver function and outcomes in the phase III REFLECT study inpatients with unresectable hepatocellular carcinoma (uHCC). J Clin
Oncol 2020;38. 524-524.
[48] Ueshima K, Nishida N, Hagiwara S, Aoki T, Minami T, Chishina H, et al.
Impact of baseline ALBI grade on the outcomes of hepatocellular carcinoma patients treated with lenvatinib: a multicenter study. Cancers(Basel) 2019;11:952.
[49] Shimose S, Iwamoto H, Niizeki T, Shirono T, Noda Y, Kamachi N, et al.
Clinical signiﬁcance of adverse events for patients with unresectable
hepatocellular carcinoma treated with lenvatinib: a multicenter retrospective study. Cancers (Basel) 2020;12:1867.
[50] Shimose S, Kawaguchi T, Iwamoto H, Tanaka M, Miyazaki K, Ono M, et al.
Controlling nutritional status (CONUT) score is associated with overall
survival in patients with unresectable hepatocellular carcinoma treatedwith lenvatinib: a multicenter cohort study. Nutrients 2020;12:1076.

JHEP Reports 2022 vol. 4 j 100557

8

[51] Hatanaka T, Kakizaki S, Nagashima T, Namikawa M, Tojima H, Shimada Y,
et al. Analyses of objective response rate, progression-free survival, andadverse events in hepatocellular carcinoma patients treated with lenvatinib: a multicenter retrospective study. Hepatol Res 2020;50:382–
395.
[52] Hatanaka T, Kakizaki S, Nagashima T, Namikawa M, Ueno T, Tojima H,
et al. Liver function changes in patients with hepatocellular carcinoma
treated with lenvatinib: predictive factors of progression to Child-Pughclass B, the formation of ascites and the candidates for the postprogression treatment. Cancers (Basel) 2020;12:2906.
[53] Hiraoka A, Kumada T, Tada T, Fukunishi S, Atsukawa M, Hirooka M, et al.
Nutritional index as prognostic indicator in patients receiving lenvatinib
treatment for unresectable hepatocellular carcinoma. Oncology
2020;98:295–302.
[54] Chan SL, Miksad R, Cicin I, Chen Y, Klumpen HJ, Kim S, et al. Outcomesbased on albumin-bilirubin (ALBI) grade in the phase III CELESTIAL trialof cabozantinib versus placebo in patients with advanced hepatocellular
carcinoma (HCC). Ann Oncol 2019;30:ix45–ix46.
[55] Kudo M, Galle PR, Brandi G, Kang YK, Yen CJ, Finn RS, et al. Effect oframucirumab on ALBI grade in patients with advanced HCC: results from
REACH and REACH-2. JHEP Rep 2021;3:100215.
[56] Kim HD, Bang Y, Lee MA, Kim JW, Kim JH, Chon HJ, et al. Regorafenib inpatients with advanced Child-Pugh B hepatocellular carcinoma: a multicentre retrospective study. Liver Int 2020;40:2544–2552.
[57] Sung PS, Jang JW, Lee J, Lee SK, Lee HL, Yang H, et al. Real-world outcomes of nivolumab in patients with unresectable hepatocellular carcinoma in an endemic area of hepatitis B virus infection. Front Oncol
2020;10:1043.
[58] Wong JSL, Kwok GGW, Tang V, Li BCW, Leung R, Chiu J, et al. Ipilimumaband nivolumab/pembrolizumab in advanced hepatocellular carcinoma
refractory to prior immune checkpoint inhibitors. J Immunother Cancer
2021;9:e001945.
[59] Pinato DJ, Kaneko T, Saeed A, Pressiani T, Kaseb A, Wang Y, et al.
Immunotherapy in hepatocellular cancer patients with mild to severe
liver dysfunction: adjunctive role of the ALBI grade. Cancers (Basel)
2020;12:1862.
[60] Demirtas CO, D’Alessio A, Rimassa L, Sharma R, Pinato DJ. The ALBI
grade: evidence for an improved model for liver functional estimation inpatients with hepatocellular carcinoma. JHEP Rep 2021;3:100347.
[61] Peng Y, Wei Q, He Y, Xie Q, Liang Y, Zhang L, et al. ALBI versus child-pughin predicting outcome of patients with HCC: a systematic review. Expert
Rev Gastroenterol Hepatol 2020;14:383–400.
[62] Mishra G, Majeed A, Dev A, Eslick GD, Pinato DJ, Izumoto H, et al. Clinicalutility of albumin bilirubin grade as a prognostic marker in patients with
hepatocellular carcinoma undergoing transarterial chemoembolization:a systematic review and meta-analysis. J Gastrointest Cancer 2022 (inpress).
[63] Chen RC, Cai YJ, Wu JM, Wang XD, Song M, Wang YQ, et al. Usefulness ofalbumin-bilirubin grade for evaluation of long-term prognosis for hepatitis B-related cirrhosis. J Viral Hepat 2017;24:238–245.
[64] Wang J, Zhang Z, Yan X, Li M, Xia J, Liu Y, et al. Albumin-Bilirubin (ALBI)
as an accurate and simple prognostic score for chronic hepatitis Brelated liver cirrhosis. Dig Liver Dis 2019;51:1172–1178.
[65] Qi XT. Albumin-bilirubin score predicts short-term mortality in patientswith hepatitis B virus-related decompensated cirrhosis. Clin Lab
2018;64:777–783.
[66] Chen B, Lin S. Albumin-bilirubin (ALBI) score at admission predicts
possible outcomes in patients with acute-on-chronic liver failure.
Medicine (Baltimore) 2017;96:e7142.
[67] Fujita K, Oura K, Yoneyama H, Shi T, Takuma K, Nakahara M, et al.
Albumin-bilirubin score indicates liver ﬁbrosis staging andprognosis in patients with chronic hepatitis C. Hepatol Res
2019;49:731–742.
[68] Chan AW, Chan RCK, Wong GLH, Wong VWS, Choi PCL, Chan HLY, et al.
New simple prognostic score for primary biliary cirrhosis: albuminbilirubin score. J Gastroenterol Hepatol 2015;30:1391–1396.
[69] Fujita K, Nomura T, Morishita A, Shi T, Oura K, Tani J, et al. Prediction oftransplant-free survival through albumin-bilirubin score in primarybiliary cholangitis. J Clin Med 2019;8:1258.
[70] Ito T, Ishigami M, Morooka H, Yamamoto K, Imai N, Ishizu Y, et al. The
albumin–bilirubin score as a predictor of outcomes in Japanese patientswith PBC: an analysis using time-dependent ROC. Sci Rep 2020;10:17812.
[71] Song Y, Yang H, Lin L, Jiang K, Liu WT, Wang BM, et al. Albumin-tobilirubin scores for assessing the prognosis in autoimmune hepatitis-

related cirrhosis. Zhonghua Gan Zang Bing Za Zhi 2019;27:772–776 (inChinese).
[72] Fragaki M, Sifaki-Pistolla D, Orfanoudaki E, Kouroumalis E. Comparativeevaluation of ALBI, MELD, and Child-Pugh scores in prognosis of
cirrhosis: is ALBI the new alternative? Ann Gastroenterol 2019;32:626–
632.
[73] Hsieh YC, Lee KC, Wang YW, Yang YY, Hou MC, Huo TI, et al. Correlationand prognostic accuracy between noninvasive liver ﬁbrosis markers andportal pressure in cirrhosis: role of ALBI score. PLoS One 2018;13:e0208903.
[74] Zou D, Qi X, Zhu C, Ning Z, Hou F, Zhao J, et al. Albumin-bilirubin score
for predicting the in-hospital mortality of acute upper gastrointestinal
bleeding in liver cirrhosis: a retrospective study. Turk J Gastroenterol
2016;27:180–186.
[75] Oikonomou T, Goulis L, Doumtsis P, Tzoumari T, Akriviadis E,
Cholongitas E. ALBI and PALBI grades are associated with the outcome ofpatients with stable decompensated cirrhosis. Ann Hepatol
2019;18:126–136.
[76] Wan SZ, Nie Y, Zhang Y, Liu C, Zhu X. Assessing the prognostic performance of the Child-Pugh, model for end-stage liver disease, andalbumin-bilirubin scores in patients with decompensated cirrhosis: alarge Asian cohort from gastroenterology department. Dis Markers
2020;2020:5193028.
[77] Peng Y, Qi X, Tang S, Deng H, Li J, Ning Z, et al. Child-Pugh, MELD, and
ALBI scores for predicting the in-hospital mortality in cirrhotic patientswith acute-on-chronic liver failure. Expert Rev Gastroenterol Hepatol
2016;10:971–980.
[78] Bernardi N, Chedid MF, Grezzana-FilhoTJM, Chedid AD, Pinto MA, Leipnitz I,
et al. Pre-transplant ALBI grade 3 is associated with increased mortality
after liver transplantation. Dig Dis Sci 2019;64:1695–1704.
[79] Zhang W, Liu C, Tan Y, Tan L, Jiang L, Yang J, et al. Albumin-bilirubin score
for predicting post-transplant complications following adult-to-adultliving donor liver transplantation. Ann Transpl 2018;23:639–646.
[80] Ma T, Li QS, Wang Y, Wang B, Wu Z, Lv Y, et al. Value of pretransplantalbumin-bilirubin score in predicting outcomes after liver transplantation. World J Gastroenterol 2019;25:1879–1889.
[81] Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al.
Development of a simple noninvasive index to predict signiﬁcantﬁbrosis in patients with HIV/HCV coinfection. Hepatology
2006;43:1317–1325.
[82] Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, DhalluinVenier V, et al. FIB-4: an inexpensive and accurate marker of ﬁbrosis in
HCV infection. Comparison with liver biopsy and FibroTest. Hepatology
2007;46:32–36.
[83] Wai CT, Greenson JK, Fontana RJ, Kalbﬂeisch JD, Marrero JA,
Conjeevaram HS, et al. A simple noninvasive index can predict bothsigniﬁcant ﬁbrosis and cirrhosis in patients with chronic hepatitis C.
Hepatology 2003;38:518–526.
[84] Fujita K, Nomura T, Morishita A, Oura K, Yoneyama H, Kobara H, et al.
Albumin-bilirubin score differentiates liver ﬁbrosis stage and hepatocellular carcinoma incidence in chronic hepatitis B virus infection: aretrospective cohort study. Am J Trop Med Hyg 2019;101:220–225.
[85] Casadei Gardini A, Foschi FG, Conti F, Petracci E, Vukotic R, Marisi G, et al.
Immune inﬂammation indicators and ALBI score to predict liver cancer
in HCV-patients treated with direct-acting antivirals. Dig Liver Dis
2019;51:681–688.
[86] Abe K, Wakabayashi H, Nakayama H, Suzuki T, Kuroda M, Yoshida N,
et al. Factors associated with hepatocellular carcinoma occurrence after
HCV eradication in patients without cirrhosis or with compensatedcirrhosis. PLoS One 2020;15:e0243473.
[87] Tanaka Y, Ogawa E, Huang CF, Toyoda H, Jun DW, Tseng CH, et al. HCC
risk post-SVR with DAAs in East Asians: ﬁndings from the REAL-C
cohort. Hepatol Int 2020;14:1023–1033.
[88] Caviglia GP, Troshina G, Santaniello U, Rosati G, Bombaci F, Birolo G, et al.
Long-term hepatocellular carcinoma development and predictive abilityof non-invasive scoring systems in patients with HCV-related cirrhosis
treated with direct-acting antivirals. Cancers (Basel) 2022;14:828.
[89] Fan R, Papatheodoridis G, Sun J, Innes H, Toyoda H, Xie Q, et al. aMAP risk
score predicts hepatocellular carcinoma development in chronic hepatitis patients: an international cohort collaboration. J Hepatol
2020;73:1368–1378.
[90] Johnson PJ, Innes H, Hughes DM, Kalyuzhnyy A, Kumada T, Toyoda H.
Evaluation of the aMAP score for hepatocellular carcinoma surveillance:a realistic opportunity to risk stratify. Br J Cancer 2022 (in press).

JHEP Reports 2022 vol. 4 j 100557

9

Review[91] Miyamoto Y, Enomoto H, Nishikawa H, Nishimura T, Iwata Y,
Nishiguchi S, et al. Association of the modiﬁed ALBI grade with endoscopic ﬁndings of gastroesophageal varices. In Vivo 2021;35:1163–1168.
[92] Chen PH, Hsieh WY, Su CW, Hou MC, Wang YP, Hsin IF, et al. Combination of albumin-bilirubin grade and platelets to predict a compensated patient with hepatocellular carcinoma who does not requireendoscopic screening for esophageal varices. Gastrointest Endosc
2018;88:230–239.
[93] Kawaguchi T, Honda A, Sugiyama Y, Nakano D, Tsutsumi T, Tahara N,
et al. Association between the albumin-bilirubin (ALBI) score andseverity of portopulmonary hypertension (PoPH): a data-mining analysis. Hepatol Res 2021;51:1207–1218.
[94] Ozaki K, Ishida T, Ohtani T, Shimada M, Kimura H, Gabata T. Assessing
the progression of segmental ﬁbrosis in chronic liver disease using
extracellular volume fractions. Eur J Radiol 2021;145:110033.
[95] Takatsu Y, Kobayashi S, Miyati T, Shiozaki T. Hepatobiliary phase images
using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acidenhanced MRI as an imaging surrogate for the albumin-bilirubin
grading system. Eur J Radiol 2016;85:2206–2210.
[96] Takatsu Y, Nakamura M, Kobayashi S, Miyati T. Prediction of sufﬁcientliver enhancement on the gadoxetate disodium-enhanced hepatobiliary
phase imaging using transitional phase images and albumin-bilirubin
grade. Magn Reson Med Sci 2021;20:152–159.
[97] Edula RG, Muthukuru S, Moroianu S, Wang Y, Lingiah V, Fung P, et al. CA125 signiﬁcance in cirrhosis and correlation with disease severity andportal hypertension: a retrospective study. J Clin Transl Hepatol
2018;6:241–246.
[98] Shimada M, Hirashima N, Iwase H, Saito M, Kondo H, Urata N, et al. Evaluation of muscle cramp associated with liver cirrhosis with a focus on theliver function and nutritional status. Intern Med 2021;60:1343–1348.
[99] Shimizu S, Hayashi Y, Nishida S, Fujii H, Nakamura M, Yoshikura N, et al.
Albumin-bilirubin score for predicting neuropsychiatric symptoms inpatients receiving ifosfamide-based chemotherapy. J Clin Pharm Ther
2021;46:794–799.
[100] Kokubun H, Takigawa C, Chihara S, Hara S, Uezono Y. Population pharmacokinetics of methadone after oral administration in Japanese patients with cancer-related pain. J Pain Palliat Care Pharmacother2020;34:203–210.
[101] Asai Y, Yamamoto T, Sato Y. Risk assessment of micafungin-induced liver
injury using spontaneous reporting system data and electronic medical
records. J Infect Chemother 2022;28:690–695.
[102] Guha IN, Harris R, Berhane S, Dillon A, Coffey L, James MW, et al. Validation of a model for identiﬁcation of patients with compensatedcirrhosis at high risk of decompensation. Clin Gastroenterol Hepatol
2019;17:2330–2338.
[103] Sakamaki A, Takamura M, Sakai N, Watanabe Y, Arao Y, Kimura N, et al.
Longitudinal increase in albumin-bilirubin score is associated with nonmalignancy-related mortality and quality of life in patients with livercirrhosis. PLoS One 2022;17:e0263464.
[104] Kudo M, Galle PR, Brandi G, Kang YK, Yen CJ, Finn RS, et al. Effect oframucirumab on ALBI grade in patients with advanced HCC: results from
REACH and REACH-2. JHEP Rep 2020;3:100215.
[105] Vogel A, Merle P, Verslype C, Finn RS, Zhu AX, Cheng AL, et al. ALBI score
and outcomes in patients with hepatocellular carcinoma: post hoc
analysis of the randomized controlled trial KEYNOTE-240. Ther Adv Med
Oncol 2021;13. 17588359211039928.
[106] Muto H, Kuzuya T, Ito T, Ishizu Y, Honda T, Ishikawa T, et al. Transient
deterioration of albumin-bilirubin scores in early post-dose period ofmolecular targeted therapies in advanced hepatocellular carcinoma with
50% or higher liver occupation: a STROBE-compliant retrospective
observational study. Medicine (Baltimore) 2021;100:e26820.
[107] Hiraoka A, Kumada T, Atsukawa M, Hirooka M, Tsuji K, Ishikawa T, et al.
Early relative change in hepatic function with lenvatinib for unresectable
hepatocellular carcinoma. Oncology 2019;97:334–340.
[108] Johnson PJ, Berhane S, Walker AJ, Gordon FH, Ryder SD, McPherson S,
et al. Impact of direct-acting antiviral agents on liver function in patients with chronic hepatitis C virus infection. J Viral Hepat
2021;28:168–176.
[109] Nakajima T, Karino Y, Hige S, Suii H, Tatsumi R, Yamaguchi M, et al.
Factors affecting the recovery of hepatic reserve after sustained virologic
response by direct-acting antiviral agents in chronic hepatitis C virusinfected patients. J Gastroenterol Hepatol 2021;36:367–375.
[110] Ogawa E, Kawano A, Ooho A, Furusyo N, Satoh T, Takahashi K, et al. Longterm hepatic function of patients with compensated cirrhosis following

successful direct-acting antiviral treatment for hepatitis C virus infection. J Gastroenterol Hepatol 2022;37:371–377.
[111] Tada T, Kurosaki M, Nakamura S, Hasebe C, Kojima Y, Furuta K, et al. Realworld clinical outcomes of sofosbuvir and velpatasvir treatment in HCV
genotype 1- and 2-infected patients with decompensated cirrhosis: anationwide multicenter study by the Japanese Red Cross Liver Study
Group. J Med Virol 2021;93:6247–6256.
[112] Waguri N, Osaki A, Watanabe Y, Matsubara T, Yamazaki S, Yokoyama H,
et al. Balloon-occluded retrograde transvenous obliteration for gastricvarices improves hepatic functional reserve in long-term follow-up. JGH
Open 2021;5:1328–1334.
[113] Ishikawa T, Endo S, Imai M, Azumi M, Nozawa Y, Sano T, et al. Changes inthe body composition and nutritional status after long-term rifaximin
therapy for hyperammonemia in Japanese patients with hepatic encephalopathy. Intern Med 2020;59:2465–2469.
[114] Li Q, Chen C, Zhang J, Wu H, Qiu Y, Song T, et al. Prediction efﬁcacy ofprognostic nutritional index and albumin-bilirubin grade in patientswith intrahepatic cholangiocarcinoma after radical resection: a multiinstitutional analysis of 535 patients. Front Oncol 2021;11:769696.
[115] Tsilimigras DI, Hyer JM, Moris D, Sahara K, Bagante F, Guglielmi A, et al.
Prognostic utility of albumin-bilirubin grade for short- and long-term
outcomes following hepatic resection for intrahepatic cholangiocarcinoma: a multi-institutional analysis of 706 patients. J Surg
Oncol 2019;120:206–213.
[116] Yang H, Cheng Z, Han Z, Liu F, Yu X, Yu J, et al. Assessment of the outcomes of intrahepatic cholangiocarcinoma after ultrasound-guided
percutaneous microwave ablation based on albumin-bilirubin grade.
Cardiovasc Intervent Radiol 2021;44:261–270.
[117] Ni JY, An C, Zhang TQ, Huang ZM, Jiang XY, Huang JH. Predictive value ofthe albumin-bilirubin grade on long-term outcomes of CT-guided
percutaneous microwave ablation in intrahepatic cholangiocarcinoma.
Int J Hyperthermia 2019;36:328–336.
[118] Deng M, Li S, Wang Q, Zhao R, Zou J, Lin W, et al. Real-world outcomes ofpatients with advanced intrahepatic cholangiocarcinoma treated with
programmed cell death protein-1-targeted immunotherapy. Ann Med
2022;54:803–811.
[119] Wang Y, Pang Q, Jin H, Zhou L, Hu X, Qian Z, et al. Albumin-bilirubin
grade as a novel predictor of survival in advanced extrahepatic cholangiocarcinoma. Gastroenterol Res Pract 2018;2018:8902146.
[120] Fernandez-Placencia R, Berrospi-Espinoza F, Uribe-Rivera K, MedinaCana J, Chavez-Passiuri I, Sanchez-Bartra N, et al. Preoperative predictors
for 90-day mortality after pancreaticoduodenectomy in patients withadenocarcinoma of the ampulla of Vater: a single-centre retrospective
cohort study. Surg Res Pract 2021;2021:6682935.
[121] Imamura T, Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, et al.
Clinical signiﬁcance of preoperative albumin-bilirubin grade in pancreatic cancer. Ann Surg Oncol 2021;28:6223–6235.
[122] Yagyu T, Saito H, Sakamoto T, Uchinaka EI, Morimoto M, Amisaki M,
et al. Preoperative albumin-bilirubin grade as a useful prognostic indicator in patients with pancreatic cancer. Anticancer Res
2019;39:1441–1446.
[123] Sakin A, Sahin S, Sakin A, Atci MM, Yasar N, Arici S, et al. Assessment of
pretreatment albumin-bilirubin grade in pancreatic cancer patients withliver metastasis. J BUON 2020;25:1941–1946.
[124] Zhang TN, Yin RH, Wang LW. The prognostic and predictive value of thealbumin-bilirubin score in advanced pancreatic cancer. Medicine (Baltimore) 2020;99:e20654.
[125] Koh HH, Cho ES, Lee JH, Shin SJ, Lee HS, Park EJ, et al. Association ofalbumin-bilirubin grade and myosteatosis with its prognostic signiﬁcance for patients with colorectal cancer. Ann Surg Oncol 2022 (inpress).
[126] Watanabe D, Fujii H, Yamada Y, Matsuhashi N, Makiyama A, Iihara H,
et al. Association of albumin-bilirubin score in patients with colorectal
cancer receiving later-line chemotherapy with regorafenib. Int J Clin
Oncol 2021;26:1257–1263.
[127] Pereyra D, Rumpf B, Ammann M, Perrodin SF, Tamandl D, Haselmann C,
et al. The combination of APRI and ALBI facilitates preoperative risk
stratiﬁcation for patients undergoing liver surgery after neoadjuvant
chemotherapy. Ann Surg Oncol 2019;26:791–799.
[128] Abdel-Rahman O. Prognostic value of baseline ALBI score among patients with colorectal liver metastases: a pooled analysis of two randomized trials. Clin Colorectal Cancer 2019;18:e61–e68.
[129] Zhu C, Wang X, Chen S, Yang X, Sun J, Pan B, et al. Efﬁcacy of the preoperative albumin-bilirubin grade for predicting survival and outcomes

JHEP Reports 2022 vol. 4 j 100557

10

of postoperative chemotherapy for advanced gastric cancer. Cancer
Manag Res 2020;12:11921–11932.
[130] Kanda M, Tanaka C, Kobayashi D, Uda H, Inaoka K, Tanaka Y, et al. Preoperative albumin-bilirubin grade predicts recurrences after radical
gastrectomy in patients with pT2-4 gastric cancer. World J Surg
2018;42:773–781.
[131] Miwa T, Kanda M, Tanaka C, Kobayashi D, Hayashi M, Yamada S, et al.
Albumin-bilirubin score predicts tolerability to adjuvant S-1 monotherapy after curative gastrectomy. J Gastric Cancer 2019;19:183–192.
[132] Kinoshita F, Yamashita T, Oku Y, Kosai K, Ono Y, Wakasu S, et al. Prognostic impact of albumin-bilirubin (ALBI) grade on non-small lung cell
carcinoma: a propensity-score matched analysis. Anticancer Res
2021;41:1621–1628.
[133] Matsukane R, Watanabe H, Hata K, Suetsugu K, Tsuji T, Egashira N, et al.
Prognostic signiﬁcance of pre-treatment ALBI grade in advanced nonsmall cell lung cancer receiving immune checkpoint therapy. Sci Rep
2021;11:15057.
[134] Takada K, Takamori S, Shimokawa M, Toyokawa G, Shimamatsu S, Hirai F,
et al. Assessment of the albumin-bilirubin grade as a prognostic factor inpatients with non-small-cell lung cancer receiving anti-PD-1-based
therapy. ESMO Open 2022;7:100348.
[135] Zhang J, Xu Q, Zhang H, Zhang Y, Yang Y, Luo H, et al. High preoperative
albumin-bilirubin score predicts poor survival in patients with newly
diagnosed high-grade gliomas. Transl Oncol 2021;14:101038.
[136] Zhu S, Cheng Z, Hu Y, Chen Z, Zhang J, Ke C, et al. Prognostic value of thesystemic immune-inﬂammation index and prognostic nutritional index
in patients with medulloblastoma undergoing surgical resection. Front
Nutr 2021;8:754958.
[137] Ieda S, Miyamoto T, Hosomi K, Takegami M, Kawabata A. Identiﬁcation ofremaining life expectancy less than two weeks by C-reactive protein/

albumin ratio, prognostic nutritional index, Fibrosis-4 index, and albuminbilirubin score in terminal cancer patients. J Palliat Med 2022 (in press).
[138] Luo Y, Li Z, Liu J, Chong Y, Wu B. Prognostic value of the albuminbilirubin score in critically ill patients with heart failure. Ann Palliat
Med 2021;10:12727–12741.
[139] Yamada S, Kaneshiro T, Yoshihisa A, Nodera M, Amami K, Nehashi T, et al.
Albumin-bilirubin score for prediction of outcomes in heart failure patients treated with cardiac resynchronization therapy. J Clin Med
2021;10:5378.
[140] Han S, Wang C, Tong F, Li Y, Li Z, Sun Z, et al. Prognostic impact ofalbumin-bilirubin score on the prediction of in-hospital mortality inpatients with heart failure: a retrospective cohort study. BMJ Open
2022;12:e049325.
[141] Saito Y, Nakai T, Ikeya Y, Kogawa R, Otsuka N, Wakamatsu Y, et al. Clinicalsigniﬁcance of the albumin-bilirubin score in patients with heart failure
undergoing cardiac resynchronization therapy. Heart Vessels 2022 (inpress).
[142] Matsue Y, Kagiyama N, Yamaguchi T, Kuroda S, Okumura T, Kida K, et al.
Clinical and prognostic values of ALBI score in patients with acute heart
failure. Heart Lung Circ 2020;29:1328–1337.
[143] Kawata T, Ikeda A, Masuda H, Komatsu S. Association between albuminbilirubin score at admission and in-hospital mortality in patients withacute heart failure. Int Heart J 2021;62:829–836.
[144] Shi L, Zhang D, Zhang J. Albumin-bilirubin score is associated with inhospital mortality in critically ill patients with acute pancreatitis. Eur J
Gastroenterol Hepatol 2020;32:963–970.
[145] Liu J, Wu M, Xie E, Chen L, Su S, Zeng H, et al. Assessment of liverfunction for evaluation of short- and long-term outcomes in type B
aortic dissection patients undergoing thoracic endovascular aortic
repair. Front Cardiovasc Med 2021;8:643127.

JHEP Reports 2022 vol. 4 j 100557

11