Role of albumin-bilirubin score in non-malignant liver disease

The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary cholangitis,liver cirrhosis,hepatitis,liver transplantation,and liver injury.The ALBI score is often compared with classical scores such as the Child-Pugh and model for end-stage liver disease scores or other noninvasive prediction models.It is widely employed because of its immunity to subjective evaluation indicators and ease of obtaining detection indicators.An increasing number of studies have confirmed that it is highly accurate for assessing the prognosis of patients with chronic liver disease;additionally,it has demonstrated good predictive performance for outcomes beyond survival in patients with liver diseases,such as decompensation events.This article presents a review of the application of ALBI scores in various non-malignant liver diseases.

Preoperative albumin-bilirubin score and liver resection percentage determine postoperative liver regeneration after partial hepatectomy

BACKGROUND The success of liver resection relies on the ability of the remnant liver to regenerate.Most of the knowledge regarding the pathophysiological basis of liver regeneration comes from rodent studies,and data on humans are scarce.Additionally,there is limited knowledge about the preoperative factors that influence postoperative regeneration.AIM To quantify postoperative remnant liver volume by the latest volumetric software and investigate perioperative factors that affect posthepatectomy liver regenera-tion.METHODS A total of 268 patients who received partial hepatectomy were enrolled.Patients were grouped into right hepatectomy/trisegmentectomy(RH/Tri),left hepa-tectomy(LH),segmentectomy(Seg),and subsegmentectomy/nonanatomical hepatectomy(Sub/Non)groups.The regeneration index(RI)and late rege-neration rate were defined as(postoperative liver volume)/[total functional liver volume(TFLV)]×100 and(RI at 6-months-RI at 3-months)/RI at 6-months,respectively.The lower 25th percentile of RI and the higher 25th percentile of late regeneration rate in each group were defined as“low regeneration”and“delayed regeneration”.“Restoration to the original size”was defined as regeneration of the liver volume by more than 90%of the TFLV at 12 months postsurgery.RESULTS The numbers of patients in the RH/Tri,LH,Seg,and Sub/Non groups were 41,53,99 and 75,respectively.The RI plateaued at 3 months in the LH,Seg,and Sub/Non groups,whereas the RI increased until 12 months in the RH/Tri group.According to our multivariate analysis,the preoperative albumin-bilirubin(ALBI)score was an independent factor for low regeneration at 3 months[odds ratio(OR)95%CI=2.80(1.17-6.69),P=0.02;per 1.0 up]and 12 months[OR=2.27(1.01-5.09),P=0.04;per 1.0 up].Multivariate analysis revealed that only liver resection percentage[OR=1.03(1.00-1.05),P=0.04]was associated with delayed regeneration.Furthermore,multivariate analysis demonstrated that the preoperative ALBI score[OR=2.63(1.00-1.05),P=0.02;per 1.0 up]and liver resection percentage[OR=1.02(1.00-1.05),P=0.04;per 1.0 up]were found to be independent risk factors associated with volume restoration failure.CONCLUSION Liver regeneration posthepatectomy was determined by the resection percentage and preoperative ALBI score.This knowledge helps surgeons decide the timing and type of rehepatectomy for recurrent cases.

Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis

BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in patients of the high-risk group was 23.33(95%CI:3.88-140.12,P=0.001).CONCLUSION The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.

Albumin-bilirubin score in non-malignant liver diseases should be properly validated

The albumin-bilirubin(ALBI)score to assess the risk of decompensation in patients with initially compensated cirrhosis may improve their prognostic evaluation.This letter critically evaluates the research,which utilizes the ALBI score to forecast decompensation in cirrhosis patients over a three-year period.This score was initially developed to assess liver function in hepatocellular carcinoma,its prognostic utility for non-malignant liver diseases has now been explored,recognizing decompensation as a pivotal event that significantly affects patient’s survival.Some concerns regarding the methodology of this research may be raised,particularly the exclusive use of radiological diagnosis,potentially including patients without definite cirrhosis and thus skewing the decompensation risk assessment.The reported predominance of variceal bleeding as a decompensating event conflicts with established literature,that often reports ascites as the initial decompensation manifestation.The letter highlights the absence of details on esophageal varices and their management,which could introduce bias in evaluating the ALBI score's predictive power.Furthermore,the letter points out the small sample size of patients with high-risk ALBI grades,potentially compromising the score's validity in this context.We suggest prospective future research to investigate the dynamic changes in the ALBI score over time to reinforce the validity of the ALBI score as a predictor of decompensation in non-malignant liver disease.

Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

BACKGROUND Modified albumin-bilirubin(mALBI)grade has been established as a survival determinant in hepatocellular carcinoma(HCC)patients who receive locoregional and targeted therapies.AIM To investigate whether mALBI could predict survival in unresectable HCC(uHCC)patients who were treated with atezolizumab plus bevacizumab(AB).METHODS A single-center,retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June 2023.An association between mALBI and patient survival was determined using Cox proportional hazards analysis.RESULTS Of the 83 patients,67 patients(80.7%)were male with the mean age of 60.6 years.Among them,22 patients(26.5%)were classified as Barcelona Clinic Liver Cancer B,and 61 patients(73.5%)were classified as Barcelona Clinic Liver Cancer C.Cirrhosis was present in 76 patients(91.6%),with 58 patients classified as Child-Turcotte-Pugh(CTP)A and 18 as CTP B.The median overall survival(OS)and progression-free survival were 13.0 mo[95%confidence interval(CI):5.2-20.8]and 9.0 mo(95%CI:5.0-13.0),respectively.The patients were divided into two groups based on mALBI grades:42 patients(50.6%)in the mALBI 1+2a group;and 41 patients(49.4%)in the mALBI 2b+3 group.During the median follow-up period of 7.0 mo,the mALBI 1+2a group exhibited significantly better survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 3.0 mo(95%CI:0.1-6.0,P<0.001).In a subgroup of patients with CTP A,the mALBI 1+2a group also showed significantly longer survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 6.0 mo(95%CI:3.4-8.6,P<0.001).In the multivariate analysis,both CTP class and mALBI grade were independently associated with survival,with adjusted hazard ratios(95%CI)of 2.63(1.19-5.78,P=0.020)and 3.90(1.71-8.90,P=0.001),respectively.CONCLUSION mALBI grades can determine survival of uHCC patients receiving AB treatment,particularly those who have mildly impaired liver function.This highlights the importance of assessing mALBI before initiating AB treatment to optimize therapeutic efficacy in clinical practice.

Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy

BACKGROUND Albumin-bilirubin(ALBI)score is an indicator of liver dysfunction and is useful for predicting prognosis of hepatocellular carcinomas.Currently,this liver function index has been used to predict prognosis in other neoplasms.However,the significance of ALBI score in gastric cancer(GC)after radical resection has not been elucidated.AIM To evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.METHODS Patients with GC who underwent curative intended gastrectomy were retrospectively evaluated from our prospective database.ALBI score was calculated as follows:(log10 bilirubin×0.660)+(albumin×-0.085).The receiver operating characteristic curve with area under the curve(AUC)was plotted to evaluate the ability of ALBI score in predicting recurrence or death.The optimal cutoff value was determined by maximizing Youden’s index,and patients were divided into low and high-ALBI groups.The Kaplan-Meier curve was used to analyze the survival,and the log-rank test was used for comparison between groups.RESULTS A total of 361 patients(235 males)were enrolled.The median ALBI value for the entire cohort was-2.89(IQR-3.13;-2.59).The AUC for ALBI score was 0.617(95%CI:0.556-0.673,P<0.001),and the cutoff value was-2.82.Accordingly,211(58.4%)patients were classified as low-ALBI group and 150(41.6%)as high-ALBI group.Older age(P=0.005),lower hemoglobin level(P<0.001),American Society of Anesthesiologists classification III/IV(P=0.001),and D1 lymphadenectomy P=0.003)were more frequent in the high-ALBI group.There was no difference between both groups in terms of Lauren histological type,depth of tumor invasion(pT),presence of lymph node metastasis(pN),and pathologic(pTNM)stage.Major postoperative complication,and mortality at 30 and 90 days were higher in the high-ALBI patients.In the survival analysis,the high-ALBI group had worse disease-free survival(DFS)and overall survival(OS)compared to those with low-ALBI(P<0.001).When stratified by pTNM,the difference between ALBI groups was maintained in stage I/II and stage III CG for DFS(P<0.001 and P=0.021,respectively);and for OS(P<0.001 and P=0.063,respectively).In multivariate analysis,total gastrectomy,advanced pT stage,presence of lymph node metastasis and high-ALBI were independent factors associated with worse survival.CONCLUSION The preoperative ALBI score is able to predict the outcomes of patients with GC,where high-ALBI patients have worse prognosis.Also,ALBI score allows risk stratification of patients within the same pTNM stages,and represents an independent risk factor associated with survival.

Platelet-albumin-bilirubin score - a predictor of outcome of acute variceal bleeding in patients with cirrhosis

BACKGROUND The albumin-bilirubin(ALBI)score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma.Incorporating platelet count in the platelet-albumin-bilirubin(PALBI)score improved validity in predicting outcome of patients undergoing resection and ablation.AIM To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.METHODS The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed.Child Turcotte Pugh(CTP)class,Model of End-stage Liver Disease(MELD),ALBI and PALBI scores were calculated on admission,and were correlated to the outcome of variceal bleeding.Areas under the receivingoperator characteristic curve(AUROC)were calculated for survival and rebleeding.RESULTS Mean age was 52.6 years;1176 were male(77.5%),69 CTP-A(4.5%),434 CTP-B(29.2%),1014 CTP-C(66.8%);306 PALBI-1(20.2%),285 PALBI-2(18.8%),and 926 PALBI-3(61.1%).Three hundred and thirty-two patients died during hospitalization(21.9%).Bleeding-related mortality occurred in 11%of CTP-B,28%of CTP-C,in 21.8%of PALBI-2 and 34.4%of PALBI-3 patients.The AUROC for predicting survival of acute variceal bleeding was 0.668,0.689,0.803 and 0.871 for CTP,MELD,ALBI and PALBI scores,respectively.For predicting rebleeding the AUROC was 0.681,0.74,0.766 and 0.794 for CTP,MELD,ALBI and PALBI scores,respectively.CONCLUSION PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.

Value of pretransplant albumin-bilirubin score in predicting outcomes after liver transplantation

BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.

Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma

BACKGROUND An ideal staging system for hepatocellular carcinoma(HCC)should rely on the hepatic reserve function and tumor burden.With the improvement in diagnostic and treatment strategies for HCC,in addition to recent treatment of viral hepatitis,finding a suitable assessment tool for hepatic reserve has become mandatory.AIM To validate a recently proposed modified albumin-bilirubin-TNM(mALBI-T)grade as a prognostic model for patients with HCC in Egypt.METHODS For patients diagnosed with HCC,Child-Turcotte-Pugh(CTP)score,Barcelona Clinic Liver Cancer(BCLC)stage,albumin-bilirubin(ALBI),plateltetalbumin– bilirubin(PALBI),ALBI-based BCLC,ALBI-T and mALBI-T grades were estimated.Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive.Overall survival and received treatments were determined.Survival data were analyzed.RESULTS A total of 1910 patients were included(mean age,57 years;1575 males).At presentation,50.6%had CTP A,36.1%had CTP B and 13.4%had CTP C;12%had ALBI grade 1,62.3%had ALBI grade 2 and 24.7%had ALBI grade 3.Overall median survival was 13 mo;survival was better in patients with ALBI 1 than in those with ALBI 2 and 3(28.6 vs 14 and 5.8 mo,respectively,P<0.001).Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2,3,4 and 5(P<0.001).The modified ALBI-T showed better stratification and significant improvement in prediction of survival.CONCLUSION ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage.mALBI-T is a better prognostic model in patients with HCC.

Modified Child-Pugh grade vs albumin-bilirubin grade for predicting prognosis of hepatocellular carcinoma patients after hepatectomy

BACKGROUND Hepatectomy is the main treatment for patients with hepatocellular carcinoma(HCC)and it has a high possibility for long-term cure potential.But the postoperative mortality and recurrence rates remain high.Since the long-term prognosis of HCC patients is strongly linked to liver function,preoperative assessment of liver function is very important for HCC patients.AIM To compare the predictive power of the modified Child-Pugh(MCP)and albumin-bilirubin(ALBI)grades for the long-term outcome of HCC.METHODS From January 2010 to June 2017,a total of 204 patients with HCC who underwent surgery at the Second Affiliated Hospital of Chongqing Medical University were enrolled in this retrospective study.Multivariate Cox regression analysis was used to determine the independent predictive factors of survival and relapse.The area under the curve(AUC)was used to evaluate the discriminative performance of the MCP grade and ALBI grade to predict the postoperative overall survival(OS)time and recurrence-free survival(RFS)time.RESULTS The median OS and RFS times were 44.0 mo(range:22.0-74.0 mo)and 22.0 mo(range:5.0-45.0 mo),respectively.The median OS and RFS times of MCP grades 1,2,and 3 patients were 60.0,39.0,and 18.0 mo(P<0.001)and 36.0,15.0,and 7.0 mo(P<0.001),respectively.The median OS and RFS times of ALBI grades 1,2,and 3 patients were 56.0,26.0,and 6.0 mo(P<0.001)and 25.0,10.0,and 3.0 mo(P=0.003),respectively.Both the MCP and ALBI grades were more accurate than the Child-Pugh grade for predicting long-term prognosis.Further analysis demonstrated that for both predicting OS and RFS,the MCP grade performed better than the ALBI grade(AUC:0.642 vs 0.605 for OS;0.659 vs 0.594 for RFS).CONCLUSION The MCP grade is more accurate than the ALBI grade for predicting long-term outcome of patients with HCC.

Nomogram based on albumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation

Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods:From April 2005 to January 2018,183 treatment-naIve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently.The overall survival(OS)and recurrence-free survival(RFS)were compared between groups classified by ALBI grade.Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results:The cumulative OS rates at 1-,3-,5-and 10-year were 97.7%,73.6%,54.5%and 34.5%,respectively.Stratified according to ALBI grade,the 1-,3-,and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%,92.4%,77.9% and 97.7%,52.3%,38.6%,respectively,with significant statistical difference(P<0.001).No significant statistical difference was detected in the1-,3-,and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P=0.220).The major complication rate was 1.6%.Multivariate analysis results showed age,α-fetoprotein level,tumor number,platelet count,location,Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS,which generated the nomograms.Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839)in OS.Conclusions:This nomogram based on ALBI grade was a visualization risk model,which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.

Post-operative albumin-bilirubin grade predicts long-term outcomes among Child–Pugh grade A patients with hepatocellular carcinoma after curative resection

Background: Although Child–Pugh grade A patients with hepatocellular carcinoma(HCC) are candidates for curative resection, some may have a poor prognosis. The albumin-bilirubin(ALBI) grade, a measure of liver function based on albumin and bilirubin, has the potential to detect Child–Pugh grade A HCC patients with poor prognosis. Because components of the ALBI grade can be measured easily even after surgery, we explored the predictive values of ALBI in patient prognosis after HCC resection. Methods: In this retrospective case-control study, we included 136 HCC patients who underwent curative resection between January 2004 and December 2013 at our hospital. ALBI grade was calculated from laboratory data recorded the day before surgery and at post-operative day 5. Results: Pre-and post-operative ALBI grade predicted patients’ long-term outcomes( P = 0.020 and P < 0.001, respectively, for overall survival, and P = 0.012 and P = 0.015, respectively, for recurrence-free survival). Post-operative ALBI grade was associated with patients’ surgical factors of repeated hepatic resection( P = 0.012), intra-operative bleeding( P = 0.006), and surgery duration( P = 0.033). Furthermore, post-operative ALBI grade, rather than pre-operative ALBI grade, was an independent predictive factor of long-term outcome of Child–Pugh grade A patients with HCC. Conclusions: Post-operative ALBI grade is useful to predict the prognosis in patients after HCC resection.

Albumin–bilirubin grade as a predictor of survival in hepatocellular carcinoma patients with thrombocytopenia

BACKGROUND The models for assessing liver function,mainly the Child–Pugh(CP),albuminbilirubin(ALBI),and platelet–ALBI(PALBI)classifications,have been validated for use in estimating the prognosis of hepatocellular carcinoma(HCC)patients.However,thrombocytopenia is a common finding and may influence the prognostic value of the three models in HCC.AIM To investigate and compare the prognostic performance of the above three models in thrombocytopenic HCC patients.METHODS A total of 135 patients with thrombocytopenic HCC who underwent radical surgery were retrospectively analyzed.Preoperative scores on the CP,ALBI and PALBI classifications were estimated accordingly.Kaplan–Meier curves with logrank tests and Cox regression models were used to explore the significant factors associated with overall survival(OS)and recurrence-free survival(RFS).RESULTS The preoperative platelet counts were significantly different among the CP,ALBI and PALBI groups.After a median follow-up of 28 mo,39.3%(53/135)of the patients experienced postoperative recurrence,and 36.3%(49/135)died.Univariate analysis suggested thatα-fetoprotein levels,tumor size,vascular invasion,and ALBI grade were significant predictors of OS and RFS.According to the multivariate Cox regression model,ALBI was identified as an independent prognostic factor.However,CP and PALBI grades were not statistically significant prognostic indicators.CONCLUSION The ALBI grade,rather than CP or PALBI grade,is a significant prognostic indicator for thrombocytopenic HCC patients.

Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albuminbilirubin score

BACKGROUND Acute liver failure(ALF)is a common cause of postoperative death in patients with hepatocellular carcinoma(HCC)and is a serious threat to patient safety.The neutrophil-to-lymphocyte ratio(NLR)is a common inflammatory indicator that is associated with the prognosis of various diseases,and the albumin-bilirubin score(ALBI)is used to evaluate liver function in liver cancer patients.Therefore,this study aimed to construct a predictive model for postoperative ALF in HCC tumor integrity resection(R0)based on the NLR and ALBI,providing a basis for clinicians to choose appropriate treatment plans.AIM To construct an ALF prediction model after R0 surgery for HCC based on NLR and ALBI.METHODS In total,194 patients with HCC who visited The First People’s Hospital of Lianyungang to receive R0 between May 2018 and May 2023 were enrolled and divided into the ALF and non-ALF groups.We compared differences in the NLR and ALBI between the two groups.The risk factors of ALF after R0 surgery for HCC were screened in the univariate analysis.Independent risk factors were analyzed by multifactorial logistic regression.We then constructed a prediction model of ALF after R0 surgery for HCC.A receiver operating characteristic curve,calibration curve,and decision curve analysis(DCA)were used to evaluate the value of the prediction model.RESULTS Among 194 patients with HCC who met the standard inclusion criteria,46 cases of ALF occurred after R0(23.71%).There were significant differences in the NLR and ALBI between the two groups(P<0.05).The univariate analysis showed that alpha-fetoprotein(AFP)and blood loss volume(BLV)were significantly higher in the ALF group compared with the non-ALF group(P<0.05).The multifactorial analysis showed that NLR,ALBI,AFP,and BLV were independent risk factors for ALF after R0 surgery in HCC.The predictive efficacy of NLR,ALBI,AFP,and BLV in predicting the occurrence of ALT after R0 surgery for HCC was average[area under the curve(AUC)NLR=0.767,AUCALBI=0.755,AUCAFP=0.599,AUCBLV=0.718].The prediction model for ALF after R0 surgery for HCC based on NLR and ALBI had a better predictive efficacy(AUC=0.916).The calibration curve and actual curve were in good agreement.DCA showed a high net gain and that the model was safer compared to the curve in the extreme case over a wide range of thresholds.CONCLUSION The prediction model based on NLR and ALBI can effectively predict the risk of developing ALF after HCC R0 surgery,providing a basis for clinical prevention of developing ALF after HCC R0 surgery.

胆红素总量/白蛋白比值、听力筛查及MRI-T_(1)WI影像对新生儿急性胆红素脑病的诊断价值

目的:探究胆红素总量/白蛋白比值(B/A)、听力筛查及磁共振成像-T_(1)加权成像(MRI-T_(1)WI)对新生儿急性胆红素脑病(ABE)的诊断价值。方法:选取2013年6月—2023年6月于太仓市第一人民医院接受治疗的136例新生儿高胆红素血症(NHB)患儿作为研究对象,根据是否并发ABE分为并发组(n=42)和对照组(n=94)。对比两组的临床资料、B/A水平、听力筛查结果、苍白球T_(1)WI信号强度,对单因素分析有意义的指标进行多因素logistic回归分析,采用ROC曲线分析其对新生儿ABE的诊断价值。结果:并发组总血清胆红素(TSB)峰值、B/A水平均高于对照组,差异有统计学意义(P<0.05)。并发组初筛听力异常率为38.10%,复筛听力异常率为35.71%,均高于对照组的18.09%、8.51%,差异有统计学意义(P<0.05)。并发组苍白球与额叶脑皮质T_(1)WI信号强度比值(G/Gr)水平高于对照组,差异有统计学意义(P<0.05)。logistic回归分析显示,B/A、听力异常和G/Gr水平表达均为影响NHB患儿并发ABE的独立危险因素,差异有统计学意义(P<0.05)。ROC曲线分析显示,B/A、G/Gr、听力异常及三者联合检测NHB患儿并发ABE的AUC值分别为0.773、0.652、0.754、0.863,有较高诊断价值,且联合诊断价值最高(P<0.05)。结论:ABE患儿中B/A、听力异常和G/Gr表达水平明显升高,三者单独和联合检测NHB患儿并发ABE均有较高诊断价值,其中三者联合诊断效果最佳。

白蛋白-胆红素评分联合肝功能指标及CEA对结直肠癌肝转移的预测价值

目的 探讨白蛋白-胆红素(albumin-bilirubin,ALBI)评分联合肝功能指标及癌胚抗原(carcinoembryonic antigen,CEA)对结直肠癌肝转移的预测价值。方法 回顾性分析2016年1月至2021年7月于兰州大学第二医院接受手术治疗且随访满24个月的结直肠癌患者临床资料,依据随访结果将入组患者分为肝转移组和非肝转移组,并按2∶1比例随机分为建模组与验证组。分析结直肠癌患者发生肝转移的风险因素,采用Lasso-Logistic回归构建预测模型,采用Bootstrap法进行内部验证,应用受试者工作特征曲线、校准曲线和临床决策曲线评价预测模型的可靠性,最后绘制列线图展示预测结果。结果 共入选符合纳入和排除标准的结直肠癌患者195例,其中建模组130例,验证组65例;Lasso回归变量筛选及Logistic回归分析结果显示,ALBI评分(OR=8.062,95%CI:2.545~25.540)、丙氨酸氨基转移酶(alanine transaminase,ALT)(OR=1.037,95%CI:1.004~1.071)与CEA(OR=1.025,95%CI:1.008~1.043)是结直肠癌发生肝转移的独立预测因素;建模组三者联合预测结直肠癌发生肝转移的曲线下面积(area under the curve,AUC)为0.921,灵敏度为78.0%,特异度为95.0%,C-index为0.921,H-L拟合度曲线χ~2=0.851,P=0.654,校准曲线斜率接近1,提示该模型准确度较高,临床决策曲线显示该模型具有良好的临床应用价值。对建模组数据采用Bootstrap法进行1000次重抽样的内部验证,准确度为0.869,Kappa一致性为0.709,AUC为0.913;应用ALBI评分、ALT与CEA单独诊断结直肠癌肝转移时,CEA的AUC最大(0.897),三者联合诊断结直肠癌肝转移的效能最高。验证组三者联合预测结直肠癌发生肝转移的AUC为0.918,灵敏度为85.0%,特异度为95.6%,C-index为0.918,H-L拟合度曲线χ~2=0.586,P=0.746。结论 ALBI评分、ALT与CEA对结直肠癌肝转移具有一定预测价值,三者联合预测结直肠癌肝转移的效能较高,通过其构建的风险预测模型具有良好的临床应用前景。

基于DECT的碘斜率无创评估肝硬化患者肝功能的相关研究

目的:探究碘斜率无创评估肝硬化患者肝功能分级的相关研究,确定碘斜率在肝硬化患者中的应用价值。方法:前瞻性收集包头市中心医院2022年5月至2023年6月期间行腹部双能量CT(DECT)患者,筛选经临床/病理诊断为肝硬化患者59例(ALBI 1、2、3级分别27例、23例、9例),同时选取健康对照患者15例,收集所有入组对象基线资料。通过DECT扫描的动脉期、门脉期、延时期获取碘值以及各期相间隔时间计算碘斜率,采用白蛋白-胆红素评分(ALBI)进行肝功能分级。使用Spearman相关系数分析碘斜率与ALBI之间的相关性;使用单因素方差分析及非参数K-W检验比较组间碘斜率的差异性;使用受试者操作特征(ROC)曲线评估碘斜率鉴别不同肝功能分组的诊断效能,并计算其截断值、敏感度、特异度以及ROC曲线下面积(AUC)。结果:λ1、λ2与ALBI分级(r=-0.82,P<0.01;r=-0.66,P<0.01)间均存在显著负相关;λ1在对照组、肝硬化组ALBI分级各组间差异均有统计学意义(P<0.001),λ2在对照组和肝硬化组间差异具有统计学意义(P<0.001);λ1鉴别对照组vs. ALBI 1级、ALBI 1级vs. ALBI 2级、ALBI 2级vs. ALBI 3级的AUC为0.80、0.86、0.96;λ2鉴别对照组vs. ALBI 1级、ALBI 1级vs. ALBI 2级、ALBI 2级vs. ALBI 3级的AUC为0.64、0.78、0.76。结论:基于DECT的碘斜率与ALBI有显著相关性,能够作为评估肝硬化患者肝功能的可靠指标,且随着肝硬化的加重,评估效能也逐渐提高,具有一定的临床应用价值。

基于白蛋白-胆红素指数构建肝硬化并发急性上消化道出血的预测模型

目的:探讨白蛋白-胆红素(ALBI)指数对肝硬化患者并发急性上消化道出血的预测价值,并建立相关预测模型。方法:选取2019年12月至2022年12月收治的肝硬化患者并发急性上消化道出血作为研究对象,收集患者临床资料,采用ROC曲线评估ALBI指数的预测价值,并计算最佳截断值。采用单因素和多因素Logistic回归分析肝硬化患者并发急性上消化道出血的影响因素,并据此建立列线图模型。结果:ALBI指数预测肝硬化患者并发急性上消化道出血的ROC曲线下面积为0.764(95%CI=0.693~0.835)。病程较长、腹水、Ca<2.2 mmol/L、PT≥16 s、PLT<100×109/L和ALBI指数≥-1.87是肝硬化患者并发急性上消化道出血的独立危险因素(P<0.05)。据此建立预测肝硬化患者并发急性上消化道出血风险的列线图模型,模型验证结果显示一致性指数(C-index)为0.854,校准曲线趋近于理想曲线,ROC曲线的AUC为0.851(95%CI=0.823~0.879),在5%~96%预测范围内模型净获益。结论:ALBI指数对肝硬化患者并发急性上消化道出血具有较高的预测价值,基于ALBI指数构建的列线图模型能够有效预测该类患者的风险。

白蛋白-胆红素评分对急性失代偿心力衰竭患者短期死亡风险的预测价值

目的探讨白蛋白-胆红素(albumin-bilirubin,ALBI)评分对急性失代偿性心力衰竭(ADHF)患者短期全因死亡的预测价值,联合急性失代偿性心力衰竭国家注册研究(ADHERE)模型能否提高其预测能力。方法连续入选2018年1月至2021年3月在南京鼓楼医院心内科住院的ADHF患者共821例。根据入院ALBI评分,采用三分位法进行分组:低ALBI组(<-2.41,n=273),中ALBI组(-2.41~-2.10,n=274),高ALBI组(≥-2.10,n=274)。比较各组基线临床特征及实验室检查,主要终点为短期(院内或出院后30天内)全因死亡。采用logistics回归分析短期全因死亡的独立危险因素,绘制受试者工作特征(ROC)曲线,计算各模型ROC曲线下面积(AUC),根据约登指数确定最佳临界值,并计算不同模型间净重新分类指数(NRI),采用Z检验比较模型间AUC及NRI的差异。结果共有45例(5.48%)患者在院内及出院后30天内死亡。高ALBI组患者全因死亡率显著高于其他两组(P<0.001)。多因素logistics回归分析显示,ALBI评分(OR=4.012,95%CI 1.598~10.073,P=0.003)、ADHERE模型(OR=2.471,95%CI 1.317~4.434,P=0.004)、B型利钠肽水平(OR=1.000,95%CI 1.000~1.001,P=0.002)是ADHF患者短期全因死亡的独立危险因素。ALBI评分预测短期死亡的最佳临界值为-2.024。ALBI联合ADHERE评分对ADHF患者短期全因死亡的预测能力优于单独评分(ALBI+ADHERE比ADHERE:AUC P=0.008;NRI=0.37,95%CI 0.14~0.56,P<0.001;ALBI+ADHERE比ALBI:NRI=0.37,95%CI 0.14~0.56,P<0.001)。结论ALBI评分与ADHF患者短期全因死亡风险独立相关,且ALBI联合ADHERE模型的预测价值更高。

年龄联合白蛋白-胆红素评分对经颈静脉肝内门体分流术后显性肝性脑病的预测价值

目的探讨年龄联合白蛋白-胆红素(ALBI)评分对肝硬化伴食管胃底静脉曲张破裂出血(EGVB)患者经颈静脉肝内门体分流术(TIPS)治疗后显性肝性脑病(OHE)的预测价值。方法回顾性分析87例接受TIPS治疗的肝硬化伴EGVB患者的临床资料,术后随访6个月,根据是否发生OHE将患者分为OHE组27例和非OHE组60例。通过单因素分析筛选出2组间差异有统计学意义的指标,对其进行二元Logistic回归分析,明确OHE发生的独立影响因素。绘制受试者工作特征(ROC)曲线,评估各独立影响因素单独及联合预测OHE的效能,应用MedCalc软件比较不同曲线下面积(AUC)的差异。结果87例患者中,27例患者术后6个月内发生OHE,发病率为31.03%。单因素分析结果显示,OHE组年龄、白蛋白、血钠、ALBI评分与非OHE组比较,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,年龄(OR=1.08,95%CI:1.02~1.14,P=0.01)、ALBI评分(OR=13.68,95%CI:3.00~62.44,P<0.01)均为肝硬化伴EGVB患者TIPS治疗后发生OHE的独立影响因素。ROC曲线分析结果显示,年龄、ALBI评分预测OHE的AUC分别为0.67(95%CI:0.55~0.79,P=0.01)、0.72(95%CI:0.60~0.85,P<0.01);年龄联合ALBI评分预测OHE的AUC为0.80(95%CI:0.70~0.91,P<0.01),敏感度为77.8%,特异度为75.0%。年龄、ALBI评分单独预测的AUC比较,差异无统计学意义(P>0.05);年龄联合ALBI评分预测的AUC大于年龄、ALBI评分单独预测的AUC,差异有统计学意义(P<0.05)。结论年龄、ALBI评分为肝硬化伴EGVB患者TIPS治疗后发生OHE的独立影响因素,两者联用对OHE具有较高的预测效能。