Laboratory Parameters and ALBI Score for Assessing Severity of Alcoholic Hepatitis in Cirrhotic Patients

Abstract

Alcoholic hepatitis (AH) is an acute deterioration of liver and often associated with poor prognosis. The aim of this study was to analyse laboratory parameters and to evaluate the prognostic performance of albumin--bilirubin (ALBI) score for severity stratification in patients with AH and underlying cirrhosis.

This retrospective, single-centre, cross-sectional study included patients with previously undiagnosed alcoholic cirrhosis hospitalized between January 2017 and December 2021 at a tertiary referral centre in Bulgaria. Among 262 patients with alcoholic cirrhosis, 85 fulfilled the NIAAA/AASLD diagnostic criteria for AH. Disease severity was stratified using MELD-Na (< 20 vs. ≥ 21). Laboratory parameters and prognostic scores were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of ALBI, Child–Pugh score, and total bilirubin for severe AH.

Among patients with AH, 83.5% were classified as ALBI grade 3 and 77.6% as Child–Pugh class C. Severe AH (MELD-Na ≥ 21) was associated with significantly higher total bilirubin, INR, creatinine, and leukocyte counts, as well as lower serum albumin and sodium levels (p < 0.05). ROC analysis demonstrated that an ALBI cut-off of $$-0.675$$ showed the highest specificity (94.7%; AUC = 0.806), while total bilirubin ≥ 101.25 µmol/L had the highest sensitivity (93.6%; AUC = 0.846). Strong correlations were observed between ALBI and Child–Pugh scores (r = 0.883), as well as between ALBI and MELD-Na (r = 0.687, p < 0.001).

The ALBI score is a simple and objective tool with high specificity for severity assessment in alcoholic hepatitis superimposed on cirrhosis. Its combined use with total bilirubin may improve early risk stratification. Prospective studies are warranted to validate these findings.