Abstract No. 185 - Albumin/bilirubin grade (ALBI): a robust predictor of decompensation and poor outcome in high-risk patients undergoing TACE for HCC

Abstract

To assess the validity of Albumin-Bilirubin (ALBI) grade as a predictor of postoperative decompensation following superselective transarterial hepatic chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with advanced cirrhosis and hence poor hepatic reserve. Preprocedural albumin and bilirubin values in all high-risk patients who underwent their first high-risk TACE between 2009-15 were used to determine liver function according to ALBI grade. Patients were deemed high risk if pre-TACE serum bilirubin (Tbili) was ≥ 2.5mg/dL and/or Child-Pugh (CP) score ≥ 8. The tumor burden met Milan criteria and TACEs were performed subselectively. Measured outcomes included 30-day mortality and hepatic decompensation at 90 days (morbidity). 152 consecutive high-risk patients with a mean Tbili of 2.8mg/dL (2.5-5.8mg/dL) and high CP score (CP 8 = 54, 9 = 47, >9 = 51) were included in the study. Mean ALBI was -0.873 (-2.03 to 0.12). 30-day mortality 90-day morbidity was 1.3% and 14.4%, respectively. Of the 115 patients on the liver transplantation wait list, 68 (59%) patients were successfully transplanted. Multivariate analysis revealed that pre-TACE ALBI to be a robust discriminator of decompensation and poor outcome (p = 0.002), while substratification by CP score was unrevealing (p = 0.9). In patients with advanced cirrhosis, ALBI is a more accurate metric to identify patients truly at risk of decompensation after a high-risk TACE than traditional scores such as CP. Use of this scoring system may allow for risk stratification and treatment of patients typically rejected for treatment because of poor liver function via other criteria.