Albumin-bilirubin (ALBI) grade predicts liver fibrosis and prognosis in PBC

【Objectives】 Non-invasive markers of liver fibrosis in patients with primary biliary cholangitis (PBC) are needed for predicting disease progression. As the ALBI grade was established as a simple method to estimate hepatic function, we assessed its efficacy in evaluating liver fibrosis stage and disease progression in PBC.【Methods】 A total of 8769 patients with PBC were enrolled from a nationwide survey conducted by the Intractable Hepato-Biliary Disease Study Group. The predictive performance of ALBI grade was evaluated using ROC analysis, and clinical outcome was assessed using the log-rank test.【Results】 The frequency of ALBI grade 1, 2, and 3 was 63%, 33%, and 4%, respectively. The ALBI grade 2 or 3 group contained significantly more histologically advanced cases (i.e., Scheuer stage 3 or 4) (p < 0.00001). The area under the ROC curve of ALBI score for predicting liver transplantation (LT)/all-cause death and LT/liver-related death was 0.73 and 0.76, respectively. The respective cumulative rate of LT/liver-related death and LT/all-cause death at 5 years was 7% and 10%. The cumulative rate of LT/liver-related death and LT/all-cause death at 5 years in the ALBI grade 1, 2, and 3 groups was 2%, 13%, and 54% and 3%, 18%, and 61%, respectively (log-rank test, p < 0.00001).【Conclusion】 ALBI grade at baseline had a good ability to diagnose liver fibrosis and predict prognosis in PBC.