Added value of the albumin-bilirubin score in predicting liver-related complications and mortality in metabolic-associated steatotic liver disease

BACKGROUND The albumin-bilirubin (ALBI) score is a marker of liver function and prognosis in hepatocellular carcinoma, with its utility being expanded to various liver conditions. However, its role in predicting long-term outcomes in patients with metabolic-associated steatotic liver disease (MASLD) remains unknown. AIM To determine the ability of the ALBI score in predicting the 8-year liver-related complications and all-cause mortality in MASLD. METHODS We conducted a retrospective longitudinal cohort study of 1163 patients with MASLD. MASLD was defined by a controlled attenuation parameter of > 254 dB/m on transient elastography, at least one cardiometabolic risk factor, and no excessive alcohol consumption. Odds ratio regression was employed to create based-prognostic scores with and without ALBI. The predictive accuracy of both scores, the ALBI score, and fibrosis-4 (FIB-4) were assessed using area under the receiving operating characteristic curve (AUROC) analysis and compared using the DeLong test. RESULTS Over 8 years, 100 (8.6%) participants of liver-related complications, and 86 (7.4%) died (30.2% of prior liver complications). ALBI had greater accuracy for predicting liver-related complications [AUROC = 0.72, 95% confidence interval (CI): 0.66-0.77] compared with the based-prognostic score (AUROC = 0.67, 95%CI: 0.62-0.73) and FIB-4 (AUROC = 0.64, 95%CI: 0.58-0.70). Additionally, ALBI was superior to the based-prognostic score and FIB-4 (AUROC = 0.81, 95%CI: 0.76-0.86 vs AUROC = 0.78, 95%CI: 0.72-0.83 and AUROC = 0.72, 95%CI: 0.65-0.78, respectively) for predicting all-cause mortality. Incorporating ALBI improved the prognostic score’s accuracy for both outcomes (liver complications: AUROC = 0.74, 95%CI: 0.68-0.79; all-cause mortality: AUROC = 0.83, 95%CI: 0.79-0.88). CONCLUSION The ALBI score is a robust and independent predictor of long-term liver-related complications and all-cause mortality in patients with MASLD. ALBI may have potential clinical applications for long-term risk stratification in MASLD management.