Admission albumin-bilirubin score is inferior to MELD, MELD-Na+ and child-Turcotte-Pugh score in predicting survival in Indian patients with alcohol-associated liver disease

Background and objectives

Prognostic scores are valuable tools for predicting survival in patients with chronic liver disease. Recently, the albumin-bilirubin (ALBI) score has emerged as a potential prognostic indicator in liver-related conditions. This study aimed to compare the prognostic efficacy of the ALBI score with the Model for End-stage Liver Disease (MELD), MELD-Na⁺, and Child-Turcotte-Pugh (CTP) scores in predicting survival among patients with alcohol-associated liver disease (ALD).

Methods

This study included consecutive ALD patients admitted to the Medicine and Gastroenterology wards of MKCG Medical College and Hospital, Berhampur, Odisha, India, between November 2019 and November 2022. Upon hospitalization, baseline characteristics, clinical and laboratory parameters, ALBI, MELD, MELD-Na⁺, and CTP scores were recorded. The accuracy of these scores in predicting survival up to three years was compared.

Results

A total of 490 ALD patients were included. Higher ALBI scores were observed in patients who died during hospitalization (p < 0.001), at 28 days (p < 0.001), 90 days (p < 0.001), six months (p < 0.001), one year (p < 0.001), two years (p < 0.001), and three years (p < 0.001), compared to those who survived. However, the area under the receiver operating characteristic (AUROC) curves showed that the ALBI score was inferior to MELD, MELD-Na⁺, and CTP scores in predicting survival at admission [AUROC: ALBI (0.719), MELD-Na⁺ (0.823), MELD (0.817), CTP (0.770)] and at three years [AUROC: ALBI (0.755), MELD-Na⁺ (0.787), MELD (0.758), CTP (0.784)]. Furthermore, Cox regression analysis revealed that components used in the MELD, MELD-Na⁺, and CTP scores—such as serum creatinine, serum sodium, and hepatic encephalopathy—were independent predictors of mortality, whereas the components of the ALBI score (serum albumin and serum bilirubin) were not.

Conclusions

All ALD patients in our study had high ALBI scores, corresponding to grade 3 at the time of hospitalization. Non-survivors had significantly higher ALBI scores compared to survivors. However, the CTP, MELD, and MELD-Na⁺ scores were found to be superior predictors of survival during hospitalization and up to three years post-admission, compared to the ALBI score. Validation of our findings requires larger multicenter studies with better representation of female patients. It may also be worthwhile to evaluate whether combining the ALBI score with alcohol-specific biomarkers improves prognostication.

Full text

https://www.xiahepublishing.com/2994-8754/JTG-2025-00004

The study was recently published in the Journal of Translational Gastroenterology.

Journal of Translational Gastroenterology (JTG) dedicates to improving clinical diagnosis and treatment, advancing understanding of the molecular mechanisms, and promoting translation from bench to bedside of gastrointestinal, hepatobiliary, and pancreatic diseases. The aim of JTG is to provide a forum for the exchange of ideas and concepts on basic, translational, and clinical aspects of gastroenterology, and promote cross-disciplinary research and collaboration.

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