The ability of the new ALBI scoring in predicting mortality, complications and prognostic comparison among cirrhotics

Introduction
Albumin-bilirubin (ALBI) is a newly devised scoring system for prognostication of liver cirrhosis. The ALBI has recently been validated and found superior to Child-Turcotte-Pugh score (CTP) and Model for End stage Liver Disease (MELD) in assessing severity of liver disease.

Aim
To determine the ALBI score’s mortality prediction among cirrhotics, associated complications and to compare its prognostic proficiency to that of MELD and CTP.

Material and methods
The diagnostic accuracy of CTP, MELD and ALBI scores for mortality in hospitalized cirrhotic patients was determined by receiver operating characteristic curve (ROC) analysis. The areas under the ROC curve were calculated, with confidence intervals (CI) of 95%. The best cut-off values were ascertained with the greatest specificity and sensitivity.

Results
The study showed overall in-hospital mortality of 25.5%. Median CTP score was 10.2 (IQR = 3) and area under curve (AUC) was 0.842 (95% CI: 0.817–0.868, p < 0.001) with sensitivity of 75.0% and specificity of 79.2%. Median MELD score was 20.9 (IQR = 7.2) and AUC was 0.836 (95% CI: 0.810–0.863, p < 0.001) with sensitivity of 76.6% and specificity of 76.7%. Median ALBI score was –1.1 (IQR = 1.0), and AUC of ALBI was 0.852 (95% CI: 0.826–0.879, p < 0.001) with sensitivity and specificity of 78.1%.

Conclusions
The objective prognostication and easy utilization of ALBI make it a useful alternative to MELD and CTP and therefore favour its applicability in clinical practice. Further validations in large prospective cohorts are needed for prognostic value of ALBI in cirrhosis and its complications.