ALBI Score
Liver function is classically assessed according to the Child’s-Pugh score (CPS) of which there are numerous versions. The score was empirically derived and comprises 5 variables that are perceived to impact upon survival in patients with cirrhosis – serum albumin level, serum bilirubin level, prothrombin time, degree of ascites and degree of encephalopathy. Each of the variables is given a score which can be converted to a grade – from A (best), B (intermediate) and C (worst). It is widely used across hepatology and has been adopted into the hepatocellular carcinoma field.
The ALBI score is a modern refinement of the CPS whereby all the prognostic information contained within the CPS is extracted from just the Albumin and Bilirubin levels after appropriate statistical modification (hence ALBI). Like the CPS, the score can be translated into three categories ALBI-1 (best), ALBI-2 (intermediate) and ALBI-3 (worst). The ALBI score is a prognostic algorithm that is applicable to chronic liver disease. Liver disease specificity has not been established.
Advantages of the ALBI score
- Simple to calculate
- Entirely objective
- A single definitive version is available
- Unlike CPS which, strictly speaking, should only be applied to patients with cirrhosis, the ALBI score is applicable to all stages of chronic liver disease
- Granular - serial changes can be readily documented
- An extensive literature has established that the ALBI score is at least as good, and in most situations, better than, the CPS
The original publication: Johnson PJ et al., Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach—The ALBI Grade. J Clin Oncol 2014, 33:550-558.
Independent international validation: Pinato DJ et al., The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. Journal of Hepatology 2017 vol. 66 j 338–346