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Post-hepatectomy liver failure (PHLF) is a potentially life-threatening complication following liver resection. Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease, which increases the risk of PHLF. This study aimed to investigate the ability of the combination of liver function and fibrosis markers (ALBI score and FIB-4 index) to predict PHLF in patients with HCC. Patients who underwent hepatectomy for HCC between August 2012 and September 2022 were considered for inclusion. Multivariable logistic regression analysis was used to identify factors associated with PHLF, and ALBI score and FIB-4 index were combined based on their regression coefficients. The performance of the combined ALBI-FIB4 score in predicting PHLF and postoperative mortality was compared with Child–Pugh score, MELD score, ALBI score, and FIB-4 index. A total of 215 patients were enrolled in this study. PHLF occurred in 35 patients (16.3%). The incidence of severe PHLF (grade B and grade C PHLF) was 9.3%. Postoperative 90‐d mortality was 2.8%. ALBI score, FIB-4 index, prothrombin time, and extent of liver resection were identified as independent factors for predicting PHLF. The AUC of the ALBI-FIB4 score in predicting PHLF was 0.783(95% CI : 0.694–0.872), higher than other models. The ALBI-FIB4 score could divide patients into two risk groups based on a cut-off value of − 1.82. High-risk patients had a high incidence of PHLF of 39.1%, while PHLF just occurred in 6.6% of low-risk patients. Similarly, the AUCs of the ALBI-FIB4 score in predicting severe PHLF and postoperative 90-d mortality were also higher than other models. Preoperative ALBI-FIB4 score showed good performance in predicting PHLF and postoperative mortality in patients undergoing hepatectomy for HCC, superior to the currently commonly used liver function and fibrosis scoring systems.

Background Delirium is a frequent complication in patients with bloodstream infection (BSI) and is associated with poor outcomes. The albumin–bilirubin (ALBI) score, an evidence-based index of hepatic function and systemic inflammation, has shown prognostic value in sepsis. However, its association with the risk of incident delirium in patients with BSI remains unclear. We aimed to evaluate the utility of the ALBI score in stratifying the risk of incident delirium in this population. Methods We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV database (MIMIC-IV, v3.1) involving adult patients admitted to the intensive care unit (ICU) with a first episode of BSI. The primary exposure was the baseline ALBI score, and the primary outcome was incident delirium within 7 days. To rigorously control for confounding, we adopted a doubly robust estimation strategy. Inverse probability of treatment weighting (IPTW) based on covariate-balancing propensity scores (CBPS) was applied to maximize the balance of baseline characteristics between groups. Subsequently, multivariable Fine-Gray proportional subdistribution hazard models were employed to estimate subdistribution hazard ratios (sHRs), accounting for death as a competing risk and adjusting for residual confounding using covariates identified via a hybrid feature selection strategy. Additionally, restricted cubic spline (RCS) analysis was performed to characterize dose–response relationships, and subgroup analyses were conducted to evaluate consistency across clinical strata. Results A total of 651 patients were included and stratified into low- and high-ALBI groups based on a median cutoff of -1.51. The high-ALBI group had a significantly higher 7-day cumulative incidence of delirium compared to the low-ALBI group (56.4% vs. 44.3%, Gray’s test P  = 0.004). In the fully adjusted Fine-Gray model, each 1-unit increase in the ALBI score was independently associated with an increased risk of delirium (sHR 1.80, 95% CI 1.38–2.33, P  < 0.001). Categorical analysis confirmed that patients in the high-ALBI group had nearly double the risk (sHR 1.98, 95% CI 1.38–2.83, P  < 0.001). RCS analysis revealed a non-linear, J-shaped dose–response relationship. Subgroup analyses demonstrated that these associations remained largely consistent across various clinical strata, with no significant interactions identified (P for interaction > 0.05). Conclusions Higher baseline ALBI scores are independently associated with an increased risk of 7-day incident delirium in critically ill adults with BSI. Derived from routinely available laboratory tests, the ALBI score may serve as a complementary objective marker for early risk stratification identifying patients who may benefit from preventive interventions, rather than a standalone predictive tool. Clinical trial number Not applicable.

Background The albumin-bilirubin (ALBI) score is an objective assessment of liver function. Given that the liver plays a key role in obesity-related metabolic regulation and that different metabolic phenotypes may be accompanied by different hepatic characteristics, this study aimed to investigate the relationship between ALBI score and metabolically healthy obesity (MHO). Methods Multivariable weighted logistic regression, restricted cubic spline, threshold effects analysis, subgroup analysis, and interaction tests were used to examine the relationship between ALBI score and MHO based on data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). Results A significant nonlinear positive association between ALBI score and MHO was found among 9,934 obese US adults. In a fully adjusted model, participants in the highest quartile of ALBI scores (with relatively poor liver function) had 105% higher odds of MHO than those in the lowest quartile [OR = 2.05, (95% CI: 1.33, 3.16)]. Threshold analysis identified an inflection point of −2.65, ALBI ≤ −2.65 was significantly positively associated with MHO, and ALBI > −2.65 no significant association was observed. This positive association was more pronounced in individuals older than 50 years (P for interaction = 0.018). Conclusions In obese US adults, ALBI score was positively associated with MHO status (particularly significant when ALBI < −2.65), and this association was moderated by age. Our findings suggest that ALBI score can help to reveal MHO-related hepatic characteristics.

Background and Objectives: Gastric cancer is an aggressive malignancy characterized by high recurrence rates, even following curative resection. The Albumin–Bilirubin (ALBI) score was originally established to assess hepatic functional reserve in patients with hepatocellular carcinoma (HCC). By reflecting both systemic inflammation and nutritional status, the ALBI score has demonstrated significant prognostic utility across a spectrum of solid malignancies. The present study aimed to evaluate the prognostic significance of the ALBI score in gastric cancer patients receiving adjuvant therapy after curative-intent resection. Materials and Methods: This retrospective study included 168 patients with gastric cancer who underwent curative-intent resection followed by adjuvant therapy between November 2008 and January 2021. ALBI scores were calculated from pre-treatment serum albumin and bilirubin levels. Patients were dichotomized into ALBI Grade 1 and ALBI Grade 2 based on an optimal ROC-derived cut-off value of −2.60. Survival outcomes, including overall survival (OS) and recurrence-free survival (RFS), were estimated using the Kaplan–Meier method and compared via the log-rank test. Independent prognostic factors were identified using univariate and multivariate Cox proportional hazards regression models. Results: Of the 168 patients, 56.5% were classified as ALBI Grade 1 and 43.5% as ALBI Grade 2. ALBI Grade 2 was associated with significantly shorter median RFS (18.7 vs. 72.2 months; p = 0.001) and OS (40.7 vs. 104.3 months; p = 0.003). Multivariable analysis identified ALBI Grade 2 as an independent predictor for both poor OS (HR: 1.699, p = 0.010) and RFS (HR: 1.767, p = 0.004). Pathological stage III disease was also a significant independent prognostic factor for OS (HR: 3.024) and RFS (HR: 3.049) (all p = 0.010). Additionally, elevated CEA correlated with shorter RFS (p = 0.023). Conclusions: The ALBI score is a prognostic marker for both overall and recurrence-free survival in gastric cancer patients receiving adjuvant therapy. A lower ALBI score is associated with longer survival outcomes. The ALBI score may support postoperative risk stratification and individualized follow-up planning.

Background: The albumin–bilirubin (ALBI) score, initially a hepatic function marker, may also reflect systemic inflammation and oxidative stress, both linked to the no-reflow phenomenon (NRP). This study investigates the ALBI score’s predictive value for the NRP and compares it with conventional risk models. Methods: This retrospective, single-center study included 1563 NSTE-ACS patients who underwent PCI between January 2023 and February 2024. Two predictive models were developed: (i) a fitted model with variables selected based on the XGBoost algorithm and SHapley Additive ExPlanations (SHAP) values, and (ii) an ALBI model including the ALBI score. Machine learning via the XGBoost algorithm was used for modeling, with SHAP applied to assess the significance of predictors. Results: The NRP occurred in 14.8% (231/1563) of patients. The ALBI score emerged as an independent predictor (OR = 12.10, 95% CI: 7.75–18.89, p < 0.001). The ALBI model demonstrated superior predictive power compared to the fitted model (C-index: 0.860 vs. 0.799), with significant improvements in discrimination (11.1%, p < 0.001) and reclassification (14.5%, p = 0.002). SHAP analysis ranked the ALBI score (1.025) as the strongest predictor, followed by hs-TnI (0.814), e-GFR (0.582), and pre-dilatation (0.283). The ALBI model exhibited better specificity (AUC: 0.860 vs. 0.798), calibration (Brier score: 0.088 vs. 0.102), and model fit (AIC: 964.7 vs. 1098.3) compared to the fitted model, indicating superior overall performance. Conclusions: The ALBI score significantly enhances the prediction of the NRP in NSTE-ACS patients undergoing PCI, outperforming traditional risk models. Incorporating the ALBI score into predictive frameworks may improve early risk stratification and guide clinical decision-making.

Objective Impaired right ventricular (RV)-pulmonary arterial (PA) coupling, calculated by measuring the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), can be used as an early indicator of right ventricular dysfunction (RVD) in patients with heart failure with a reduced ejection fraction (HFrEF). Patients suffering from HFrEF experience improvements in left ventricular (LV) function through the administration of sacubitril/valsartan therapy. In addition, the albumin-bilirubin (ALBI) score was associated with the fluid overload status and adverse clinical outcomes in patients with heart failure. This study aimed to assess whether angiotensin receptor-neprilysin inhibitor (ARNI) affects the TAPSE /PASP in patients with HFrEF, and whether there is a correlation between changes in the ALBI score and ARNI treatment. Methods A retrospective observational study was conducted on 305 patients with HFrEF and RVD who were hospitalized between June 2020 and December 2021. One year after treatment, laboratory test results, ALBI score, transthoracic echocardiography (TTE), New York Heart Association classification, Minnesota Living with Heart Failure Questionnaire scores and changes in relevant variables were reevaluated. Results Compared to before sacubitril/valsartan treatment, the ALBI was found to be significantly reduced after one year of follow-up (-2.42 ± 0.37 vs. -2.51 ± 0.32, p  < 0.001). Additionally, A significant improvement was demonstrated in the following echocardiography parameters assessing RV function after 1 year of treatment with sacubitril/valsartan: TAPSE (15 ± 1 vs. 18 ± 2 mm, p  < 0.001), PASP (45 ± 8 vs. 40 ± 9 mmHg, p  < 0.001), pulmonary artery diastolic pressure (PADP) (22 ± 4 vs. 19 ± 4 mmHg, p  < 0.001), RV-PA coupling (0.35 ± 0.08 vs. 0.48 ± 0.12, p  < 0.001), and RV s’(8.7 ± 2.2 vs. 9.5 ± 2.6 cm/s, p  < 0.001). Multivariate analysis showed that the improvement of RV-PA coupling was associated with baseline PASP ( r: -0.45, p  < 0.001) and PADP ( r: -0.45, p  < 0.001). Conclusions Sacubitril/valsartan improves RV-PA conjugation in patients with RVD and HFrEF, and has a positive impact on the ALBI score by improving liver function in patients with HFrEF.

Background The prognostic ability of albumin-bilirubin score (ALBI) to assess the hepatic dysfunction in patients with hepatocellular carcinoma (HCC) was previously studied. Its role in the staging of liver fibrosis post chronic hepatitis C Virus (HCV) infection needs to be investigated. Aim to assess the diagnostic value of the ALBI score compared to other non-invasive fibrosis scores in chronic HCV patients. Methods This cross-sectional study included consecutive chronic HCV patients from January 2015 till December 2018. Liver stiffness measurement (LSM) by transient elastography (TE) is currently one of the most validated noninvasive methods for liver fibrosis staging and is used in daily practice as a reference for fibrosis assessment. ALBI grade as well as Fibrosis-4 (FIB-4), Aspartate aminotransferase to platelet ratio index (APRI), LOK index and Göteborg University Cirrhosis (GUCI) scores were calculated for all of the patients. Results A total of 781 chronic HCV patients were included. Around 54% of them had compensated cirrhosis. GUCI score was the most sensitive one to difference between early fibrosis stages, F0 vs. F1. LOK index and ALBI score did not differ significantly between F1 and F2 stages unlike the other study markers. ROC curves revealed good diagnostic capability of FIB-4 (AUROC: 0.85, 0.84), APRI (AUROC: 0.83, 0.83) and GUCI score (AUROC: 0.83, 0.83) for detecting advanced fibrosis and cirrhosis, respectively. ALBI score had a moderate diagnostic role for diagnosing advanced fibrosis and cirrhosis, AUROC of 0.73 and 0.74 respectively. At a cutoff value of -2.95, the sensitivity of ALBI score approached 79%, the specificity was 53% for advanced fibrosis. Conclusion ALBI score has a moderate diagnostic power score in the diagnosis of HCV-associated advanced liver fibrosis and cirrhosis; however, FIB-4, APRI and GUCI scores outperformed the ALBI score.

Hepatocellular carcinoma (HCC) is influenced not only by tumor burden but also by liver function and the extent of fibrosis. Although the albumin-bilirubin (ALBI) score and the fibrosis-4 (FIB-4) index are validated independent predictors, their combined prognostic impact has been insufficiently examined. We retrospectively analyzed 307 patients with HCC diagnosed between 2002 and 2025. ALBI and FIB-4 scores were calculated at baseline, and a composite score was generated using the β-coefficients obtained from a multivariable Cox regression model, allowing each component to contribute proportionally to its prognostic weight (combined score = 0.503 × ALBI + 0.0576 × FIB-4). Patients were stratified using the median cutoff value (-0.95). Outcomes included overall survival (OS), event-free survival (EFS) for those undergoing locoregional therapies, and progression-free survival (PFS) for patients treated with systemic therapy. Median OS was 12.1 months. Patients with combined scores ≤-0.95 had superior OS (18.3 vs 6.8 months, p < 0.001), and the score remained an independent predictor of OS (HR 2.01, 95% CI 1.48-2.72, p = 0.001). In the locoregional therapy group, lower scores predicted improved EFS (16.4 vs 5.8 months,: HR:1.86; 95% CI:1.17-2.96; p=0.009). Among systemic therapy patients, the combined score independently predicted PFS (HR 1.70, 95% CI 1.21-2.41, p = 0.021). The combined ALBI-FIB-4 score is an accessible and reproducible prognostic marker across therapeutic settings in HCC. By integrating measures of hepatic reserve and fibrosis, it provides additional prognostic granularity beyond tumor-centric staging systems. These findings highlight its potential utility in personalized risk stratification and warrant validation in prospective, multi-ethnic cohorts.

BackgroundThe combination of atezolizumab and bevacizumab (Atezo-Bev) has become the standard first-line therapy for patients with advanced hepatocellular carcinoma (HCC), but the prognosis and treatment pattern after its treatment failure are unclear.MethodsWe reviewed the medical records of patients who failed first-line Atezo-Bev treatment for advanced HCC from January 2018 to May 2021 in four Taiwan medical centers. Post-first-line survival (PFLS) was defined as the date from the failure of Atezo-Bev treatment to the date of death or last follow-up.ResultsA total of 41 patients were included in the study. All patients had Child–Pugh A liver reserve before the initiation of Atezo-Bev treatment, but the liver reserve of 6 (15%) and 7 (17%) patients deteriorated to Child–Pugh B and C, respectively, after treatment failure. The median PFLS was 5.9 months. PFLS significantly differed among patients with various liver reserves after the failure of Atezo-Bev treatment (median 9.6 vs 3.8 vs 1.2 months, for Child–Pugh A, B, and C; p < 0.001). In total, 30 (73%) patients received second-line systemic therapy, and they exhibited significantly longer PFLS (median 8.0 vs 1.8 months, p = 0.033) than patients who did not. Deteriorated liver function and not receiving second-line therapy remained associated with inferior PFLS in multivariate analysis. The most common second-line therapies were sorafenib (n = 19, 63%) and lenvatinib (n = 9, 30%), with no significant differences in efficacies.ConclusionReceiving second-line therapy and good liver reserve were associated with favorable PFLS after the failure of first-line Atezo-Bev treatment.

Background and Aim A reliable classification for predicting postoperative prognosis and perioperative risk of hepatocellular carcinoma (HCC) patients is required to make a precise decision for HCC treatment. In the present study, we assessed the perioperative and prognostic importance of indocyanine green (ICG) testing, tumor‐node‐metastasis (TNM) stage, albumin‐bilirubin (ALBI) grade, and ALBI‐TNM (ALBI‐T) score using consecutive resected HCC cases. Methods Between 1998 and 2011, 273 consecutive patients who underwent primary and curative hepatectomy for HCC were identified. Among these 273 cases, 235 Child‐Pugh class A patients were enrolled in the present study. Results Correlation analysis showed that the value of linear predictor for ALBI grade was significantly correlated with ICG 15‐minute retention rates (r = 0.51, P < 0.0001). Survival analysis for both recurrence‐free survival (RFS) and overall survival (OS) showed there were significant differences between the two groups stratified by stage or ALBI‐T score (stage, RFS: P = 0.01, OS: P = 0.003; ALBI‐T, RFS: P < 0.0001, OS: P < 0.0001). In addition, Cox proportional hazard model identified ALBI‐T score was a significant predictor for both RFS and OS (RFS, P = 0.001; OS, P = 0.004). Furthermore, ALBI‐T score could predict perioperative risk in hepatectomy such as longer operation time and excessive intraoperative blood loss. Conclusions This study showed a robust association of ALBI‐T score with postoperative HCC patient survival and perioperative risk in hepatectomy. ALBI‐T score can be used as a simple and powerful tool for assessing HCC patients with further study. This study showed a robust association of ALBI‐T score with postoperative HCC patient survival and perioperative risk in hepatectomy. ALBI‐T score can be used as a simple and powerful tool for assessing HCC patients with further study.