Albumin-bilirubin Score Indicates Liver Fibrosis Staging and Prognosis in Patients with Chronic Hepatitis C

Overview

Journal Hepatol Res

Specialty Gastroenterology

Date 2019 Mar 21

PMID 30892804

Citations 25

Authors

Koji Fujita

Kyoko Oura

Hirohito Yoneyama

Tingting Shi

Kei Takuma

Mai Nakahara

Tomoko Tadokoro

Takako Nomura

Asahiro Morishita

Kunihiko Tsutsui

Takashi Himoto

Tsutomu Masaki

Affiliations

Soon will be listed here.

Abstract

Aim: Albumin-bilirubin (ALBI) grade was investigated to predict prognosis of patients with cirrhosis. It was defined using the ALBI score calculated based on serum total bilirubin and albumin, which represent liver function. The diagnostic accuracy for liver fibrosis staging in patients with chronic hepatitis using the ALBI score has not been investigated well. This study aimed to evaluate the diagnostic abilities of the ALBI score for liver fibrosis staging in chronic hepatitis and cirrhosis in Japanese patients with hepatitis C virus (HCV) infection.

Methods: Japanese patients with HCV infection who underwent liver biopsy examinations were enrolled in a retrospective study. Fibrosis staging and activity grading were assessed using the modified METAVIR score. The ALBI score was calculated according to the following equation: Log10 total bilirubin (μmol/L) × 0.66 + albumin (g/L) × (-0.085).

Results: A total of 382 patients were enrolled in this study. The ALBI score differentiated fibrosis stage 4 from 3 and stage 3 from 2 (P < 0.05). When an ALBI score of -2.125 was adopted as a cut-off value, the sensitivity and specificity were 73.2% and 87.1%, respectively, with a positive likelihood ratio of 5.67 to differentiate stage 4 from stages 1-3. Kaplan-Meier analysis showed that smaller ALBI scores at baseline correlated with better hepatocellular carcinoma (HCC)-free and overall survival (P < 0.05).

Conclusions: The ALBI score indicates liver fibrosis staging in Japanese patients with HCV infection. Furthermore, smaller ALBI scores predict better HCC-free survival and overall survival. The ALBI score has the potential to expand its application from cirrhosis to chronic hepatitis.

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References

Bravo A, Sheth S, Chopra S . Liver biopsy. N Engl J Med. 2001; 344(7):495-500. DOI: 10.1056/NEJM200102153440706. View

Barr R, Zhang Z . Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography. Radiology. 2014; 275(1):45-53. DOI: 10.1148/radiol.14132404. View

Colloredo G, Guido M, Sonzogni A, Leandro G . Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol. 2003; 39(2):239-44. DOI: 10.1016/s0168-8278(03)00191-0. View

Altman D, Bland J . Diagnostic tests 3: receiver operating characteristic plots. BMJ. 1994; 309(6948):188. PMC: 2540706. DOI: 10.1136/bmj.309.6948.188. View

Harimoto N, Yoshizumi T, Sakata K, Nagatsu A, Motomura T, Itoh S . Prognostic significance of combined albumin-bilirubin and tumor-node-metastasis staging system in patients who underwent hepatic resection for hepatocellular carcinoma. Hepatol Res. 2017; 47(12):1289-1298. DOI: 10.1111/hepr.12868. View

Matsushima H, Takami Y, Ryu T, Yoshitomi M, Tateishi M, Wada Y . Prognosis of Hepatocellular Carcinoma Patients Who Achieved Long-Term Recurrence-Free Survival After Curative Therapy: Impact of the ALBI Grade. J Gastrointest Surg. 2018; 22(7):1230-1238. DOI: 10.1007/s11605-018-3745-6. View

Zhang Z, Xiong L, Zhou J, Miao X, Li Q, Wen Y . Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC. World J Surg Oncol. 2018; 16(1):208. PMC: 6192221. DOI: 10.1186/s12957-018-1500-9. View

Fried M, Shiffman M, Reddy K, Smith C, Marinos G, Goncales Jr F . Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002; 347(13):975-82. DOI: 10.1056/NEJMoa020047. View

DeLong E, Delong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3):837-45. View

10.

Tapper E, Lok A . Use of Liver Imaging and Biopsy in Clinical Practice. N Engl J Med. 2017; 377(23):2296-2297. DOI: 10.1056/NEJMc1712445. View

11.

Seeff L, Everson G, Morgan T, Curto T, Lee W, Ghany M . Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010; 8(10):877-83. PMC: 3771318. DOI: 10.1016/j.cgh.2010.03.025. View

12.

Nobili V, Parkes J, Bottazzo G, Marcellini M, Cross R, Newman D . Performance of ELF serum markers in predicting fibrosis stage in pediatric non-alcoholic fatty liver disease. Gastroenterology. 2008; 136(1):160-7. DOI: 10.1053/j.gastro.2008.09.013. View

13.

Lin Z, Xin Y, Dong Q, Wang Q, Jiang X, Zhan S . Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology. 2011; 53(3):726-36. DOI: 10.1002/hep.24105. View

14.

Li M, Zhao H, Bi X, Li Z, Huang Z, Han Y . Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma: Validation in a Chinese cohort. Hepatol Res. 2016; 47(8):731-741. DOI: 10.1111/hepr.12796. View

15.

Bedossa P, Poynard T . An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996; 24(2):289-93. DOI: 10.1002/hep.510240201. View

16.

Loomba R, Wolfson T, Ang B, Hooker J, Behling C, Peterson M . Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology. 2014; 60(6):1920-8. PMC: 4245360. DOI: 10.1002/hep.27362. View

17.

Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V . FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007; 46(1):32-6. DOI: 10.1002/hep.21669. View

18.

Montoy J, Dow W, Kaplan B . Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ. 2016; 532:h6895. PMC: 4718971. DOI: 10.1136/bmj.h6895. View

19.

Fujita K, Kuroda N, Morishita A, Oura K, Tadokoro T, Nomura T . Fibrosis Staging Using Direct Serum Biomarkers is Influenced by Hepatitis Activity Grading in Hepatitis C Virus Infection. J Clin Med. 2018; 7(9). PMC: 6162836. DOI: 10.3390/jcm7090267. View

20.

Chou R, Wasson N . Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review. Ann Intern Med. 2013; 158(11):807-20. DOI: 10.7326/0003-4819-158-11-201306040-00005. View