The Modified Albumin–Bilirubin (ALBI) Grade Reflect the Fate of Limb Prognosis in Patients with Chronic Limb-Threatening Ischemia

Abstract

ObjectiveTo examine the influence of liver function on patients with chronic limb-threatening ischemia (CLTI), we classified patients with CLTI after revascularization according to their modified ALBI grades. MethodsWe retrospectively analyzed single-center data of patients who underwent revascularization for CLTI between 2015 and 2020. Patients were classified with modified albumin–bilirubin (ALBI) grades 1, 2a, and 2b & 3 according to the ALBI score, which was calculated based on serum albumin and total bilirubin levels. The endpoints were the two-year amputation-free survival (AFS) and one-year wound healing rates. ResultsWe included 190 limbs in 148 patients, and 50, 54, and 86 cases were assigned as grade 1, 2a, and 2b & 3, respectively. The two-year AFS rates for the grade 1, 2a, and 2b & 3 groups were 79 ± 6%, 66% ± 7%, and 45 ± 6%, respectively (P < 0.01). One-year cumulative wound healing rates for grade 1, 2a, and 2b & 3 groups were 68 ± 7%, 69% ± 6%, and 48% ± 5%, respectively (P = 0.01). Multivariate Cox proportional hazard analyses identified age (≥75 years), dependent ambulatory status, and modified ALBI grades 2b & 3 compared with grades 1 and 2a as significant independent predictors of AFS. The dependent ambulatory status and WIfI stage 4 were significant negative predictors of wound healing. ConclusionsMany patients with CLTI had high modified ALBI grades and impaired liver function classified as modified ALBI grade 2b or 3 is a robust negative predictor of amputation-free survival.