Prediction of Transplant-Free Survival through Albumin-Bilirubin Score in Primary Biliary Cholangitis.

Shi Shi,Morishita Morishita,Fujita Fujita,Masaki Masaki,Kobara Kobara,Nomura Nomura,Tani Tani,Himoto Himoto,Oura Oura,Tsutsui Tsutsui

doi:10.3390/jcm8081258

Abstract

Albumin–bilirubin (ALBI) grade is defined using the ALBI score, which is calculated based on total serum bilirubin and albumin. This study aimed to evaluate the diagnostic ability of the ALBI score for determining hepatic fibrosis stage and transplant-free survival in primary biliary cholangitis (PBC) patients. A total of 181 Japanese patients with biopsy-proven or serologically diagnosed PBC were enrolled. The pathological stage was assessed using the Scheuer classification. The ALBI score differentiated fibrosis in stage 4 from that of 3 in the biopsy-proven cohort (p < 0.05). With an ALBI score cut-off value of −1.679, the sensitivity and specificity were 100% and 91.1%, respectively, with a likelihood ratio of 12.3 to differentiate stage 4 from stages 1–3. The ALBI score at the beginning of ursodeoxycholic acid (UDCA) prescription correlated with the two prognostic scores calculated after 1-year UDCA treatment. Kaplan–Meier analysis showed that the baseline ALBI score differentiated liver transplant-free survival (p < 0.05). The ALBI score presented a greater hazard ratio for transplant-free survival than aspartate aminotransferase-to-platelet ratio index (APRI) in Cox proportional hazard model. In conclusion, ALBI score indicates pathological stage in Japanese PBC patients and scores before UDCA prescription predict better liver transplant-free survival, which correlated well with the two major prognostic scores. The prognosis-predicting ability of the ALBI score might surpass that of APRI.

Highlights

Primary biliary cholangitis (PBC) is a chronic, progressive, and cholestatic disease of the liver [1,2]
Two prognosis scores have been developed to predict the risk of disease progression resistant to ursodeoxycholic acid (UDCA) treatment and liver transplant; these scores are the GLOBE score and UK-PBC risk score [10,11]
This study aimed to evaluate the diagnostic ability of ALBI score for determining hepatic fibrosis stage and transplant-free survival, comparing with GLOBE score, UK-PBC risk score and aminotransferase-to-platelet ratio index (APRI) in PBC patients

Summary

Introduction

Primary biliary cholangitis (PBC) is a chronic, progressive, and cholestatic disease of the liver [1,2]. The only definitive treatment is orthotopic liver transplantation for PBC when the disease resists ursodeoxycholic acid (UDCA) treatment [3]. Two prognosis scores have been developed to predict the risk of disease progression resistant to UDCA treatment and liver transplant; these scores are the GLOBE score and UK-PBC risk score [10,11]. Both scores are based on blood exams after one year of UDCA therapy, with consideration to the therapeutic response of the disease to the therapy

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Conclusion