# ALBI Score Calculator (Albumin-Bilirubin Grade)

Predicts survival of patients with hepatocellular carcinoma (HCC) based on two markers of liver function, albumin and bilirubin.

The text below the calculator contains further information about the use of ALBI as alternative to the Child-Pugh grade and about the original study and further validations.

The Albumin-Bilirubin Grade for Hepatocellular Carcinoma (ALBI Score) is a simple model that assesses liver function based on serum albumin and bilirubin concentrations in patients with hepatocellular carcinoma to retrieve a grade with further associated median survival values.

ALBI is an alternative to the conventional Child-Pugh grade and was shown to perform at least as well, without the need for subjective variables, such as ascites and encephalopathy.

`ALBI = (log10 bilirubin × 0.66) + (albumin × -0.085)`

Where: bilirubin is in μmol/L and albumin in g/L.

ALBI Grade and Median survival interpretation:

 ALBI Score Grade Median survival ≤-2.60 1 18.5 - 85.6 months >-2.60 to ≤-1.39 2 5.3 - 46.5 months ≤-1.39 3 2.3 - 15.5 months

Albumin
Bilirubin
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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

## Albumin-Bilirubin Grade explained

The ALBI Score employs objective measures of liver function/dysfunction, i.e. serum albumin and serum bilirubin concentrations, to retrieve medial survival in patients with hepatocellular carcinoma.

`ALBI = (log10 bilirubin × 0.66) + (albumin × -0.085)`

Where bilirubin is in μmol/L and albumin in g/L.

ALBI Grade (risk categories) and Median survival interpretation:

 ALBI Score Grade Median survival ≤-2.60 1 18.5 - 85.6 months >-2.60 to ≤-1.39 2 5.3 - 46.5 months ≤-1.39 3 2.3 - 15.5 months

Survival in HCC is perceived as dependant on tumor stage, liver function and performance status.

Chronic liver disease (which is present in most HCC patients, is currently assessed by the Child-Pugh grade. However, C-P grade provides prognosis in patients with cirrhosis, whilst a variable percentage of patients with HCC, do not have cirrhosis but suffer from other liver pathologies and the degree of liver function is more likely related to the tumor.

ALBI provides an alternative to the conventional Child-Pugh grade and was shown to perform at least as well, without the need for subjective variables, such as ascites and encephalopathy.

## About the original study

The ALBI grade has been developed following an international collaboration, involving 1,313 Japanese patients with HCC of all stages. Initially, two objective measures of hepatic function/dysfunction (that can influence survival in HCC patient) were identified: i.e. serum albumin and serum bilirubin.

The model was then extensively internationally tested in several other geographical regions and other clinical situations. ALBI specificity was tested in patients with chronic liver disease but without HCC to show it’s relevance as measure of liver function, and alternative to the Child-Pugh grade.

The results of both formal statistical analysis and visual inspection indicate that the level of discrimination achieved is at least comparable to that of the conventional C-P grade.

## Other validation studies

The efficacy of the ALBI grade in assessing liver function in patients with HCC has been examined in several studies following the publication of the grade.

HCC prognostic was evaluated against results from the (1) Japan Integrated Staging (JIS), consisting of Child-Pugh classification and TNM staging (TNM), (2) modified JIS (m-JIS), consisting of liver damage grading and TNM, and (3) ALBI-TNM (ALBI-T), consisting of ALBI grading and TNM. The predictive value for prognosis of ALBI-T was found to be equal to that of JIS and m-JIS.

The prognostic value of the ALBI grade (3-month outcome) has been evaluated in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (AoCLF). The ALBI score was positively correlated with the model of the end-stage liver disease (MELD) score and Child–Pugh score.

ALBI survival prediction may be employed to help in the selection of HCC patients with better post-progression survival (PPS) for second-line treatment with Sorafenib.

## References

### Original study

Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015; 33(6):550-8.

### Validation

Hiraoka A, Michitaka K, Kumada T, et al. Validation and Potential of Albumin-Bilirubin Grade and Prognostication in a Nationwide Survey of 46,681 Hepatocellular Carcinoma Patients in Japan: The Need for a More Detailed Evaluation of Hepatic Function. Liver Cancer. 2017; 6(4):325-336.

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(24):e7142.

Lee PC, Chen YT, Chao Y, et al. Validation of the albumin-bilirubin grade-based integrated model as a predictor for sorafenib-failed hepatocellular carcinoma. Liver Int. 2018; 38(2):321-330.

Specialty: Oncology

Objective: Survival prediction

Type: Score

No. Of Variables: 2

Year Of Study: 2015

Article By: Denise Nedea

Published On: June 10, 2023 · 12:00 AM

Last Checked: June 10, 2023

Next Review: June 10, 2028