The Albumin-Bilirubin Score as a Predictor of Liver-Related Mortality in Primary Biliary Cholangitis with Compensated Cirrhosis

Introduction: Although several prognostic scores have been reported to correlate with the prognosis of primary biliary cholangitis (PBC) patients, there are limited tools to predict the prognosis of PBC with compensated cirrhosis. This study aimed to evaluate the prognostic performance of the albumin-bilirubin (ALBI) score in PBC patients with compensated cirrhosis.Methods: We conducted a retrospective longitudinal study of 219 patients with compensated PBC cirrhosis to evaluate the prognostic performance of the ALBI using Cox regression model, receiver operating characteristic curve, and Kaplan-Meier method.Results: During follow-up, a total of 19 subjects (8.7%) met the primary endpoint of liver-related death or transplantation (LT). Patients who died/underwent LT have higher ALBI score (-1.06 vs. -2.06, P <0.001) at baseline than those who survived. ALBI score (HR: 15.011, 95% CI: 5.045-44.665, P < 0.001) was associated with an increase in liver-related mortality or LT. ALBI score had the best discriminative capacity to predict the 5-year liver-related mortality [AUC: 0.871, 95% CI (0.820, 0.913)] compared with other prognostic scores. The ROC curve showed that the best cut-of value of ALBI score was -1.47, with 90.0% sensitivity and 76.6% specificity. And the probability of transplant-free survival decreased with increasing ALBI grade (log-rank P=0.003). The five-year transplant-free survival rates of patients in grade 1, grade 2, and grade 3 were 100.0%, 96.4%, and 89.4%, respectively. Conclusion: ALBI score is a simple and effective predictive factor estimating the clinical outcome of patients with compensated PBC cirrhosis and provides better prognostic performance compared with other prognostic scores.