Albi ScoreEdit

The Albi score is a compact, lab-based metric used to assess hepatic function and reserve. By relying on two routinely measured blood components—albumin and bilirubin—it offers an objective gauge of liver capacity that can complement more traditional, semi-subjective systems. First proposed for prognostic use in liver disease and cancer, the ALBI approach has since become a common tool in decisions about treatment strategy, ranging from surgical planning to locoregional therapy and transplantation considerations. Unlike some older scales, the ALBI score avoids subjective assessments of symptoms such as ascites or encephalopathy, instead yielding a numeric value that correlates with patient outcomes across a range of hepatic conditions. Albumin Bilirubin Liver function Hepatocellular carcinoma Child-Pugh score

Calculation and interpretation - The ALBI score is calculated from two laboratory values: bilirubin and albumin. Using bilirubin in μmol/L, the formula is: ALBI score = (log10 bilirubin × 0.66) + (albumin × −0.085), with albumin measured in g/L. A lower score indicates better hepatic function. - Cutoffs define three grades: - Grade 1: ALBI ≤ −2.60 - Grade 2: ALBI > −2.60 and ≤ −1.39 - Grade 3: ALBI > −1.39 These thresholds are used to stratify risk and prognosis in patients with liver disease or hepatocellular carcinoma. In many centers, a refined version called modified ALBI (mALBI) adds an extra split within Grade 2 (for example, 2a and 2b) to improve discrimination in some populations. Hepatocellular carcinoma ALBI score Albumin Bilirubin

Clinical use and applications - Prognostic stratification in liver disease: The ALBI score helps gauge hepatic reserve in patients with cirrhosis and other chronic liver conditions. That information supports clinicians when evaluating the risk of surgery or explore treatment options. Liver disease Cirrhosis - Surgical and locoregional treatment decisions: In liver resection and ablative therapies for liver tumors, ALBI can complement radiologic and anatomic assessments to estimate postoperative liver function and tolerance. It is also used to guide selection for procedures like transarterial chemoembolization (TACE) or radioembolization and other targeted therapies. Hepatectomy Ablation (medical procedure) TACE Radioembolization - Transplant evaluation and timing: ALBI scores contribute to assessments of hepatic reserve in potential transplant candidates and can be part of broader risk stratification used by transplant teams. Liver transplantation Transplantation

Evidence and comparative advantages - Objectivity and reproducibility: By relying solely on laboratory data, the ALBI score reduces interobserver variability that can arise from subjective clinical assessments. This appeals to systems focused on standardization and evidence-based triage. Evidence-based medicine Clinical guidelines - Complement to older scales: While long-standing scales such as the Child-Pugh score remain widely used, ALBI offers an independent, calculation-based perspective that can be combined with other clinical information to improve prognostication. Child-Pugh score Prognosis - Broad applicability across hepatic conditions: The score has been evaluated in various contexts, including resection outcomes, transplantation planning, and prognosis in patients with hepatocellular carcinoma and other liver diseases. Hepatology Liver cancer

Limitations and criticisms - Not a substitute for clinical judgment: Critics note that ALBI omits important clinical factors such as portal hypertension, ascites, and encephalopathy, which continue to influence prognosis and treatment tolerance. Proponents counter that ALBI complements, rather than replaces, a full clinical assessment. Portal hypertension Ascites Encephalopathy - Population and disease nuance: Some findings suggest that performance of ALBI varies with etiologies of liver disease, stages of illness, and specific treatment contexts. Consequently, guidelines often encourage integrating ALBI with other prognostic tools and patient characteristics. Etiology of liver disease Clinical outcomes - Pediatric and atypical cases: In certain populations, particularly children or unusual disease presentations, the applicability and interpretation of ALBI may differ, underscoring the need for tailored evaluation. Pediatric hepatology Pediatric liver disease

Controversies and debates (from a practical policy-oriented perspective) - Should ALBI be adopted as a standard over older, more subjective scores? Advocates argue that ALBI’s objective basis improves consistency in prognostication and care planning, supports transparent decision-making, and can streamline resource allocation. Critics warn that relying too heavily on a numeric score could downplay patient individuality, comorbidity nuances, and the broader clinical picture. The best practice, many experts contend, is to use ALBI as part of a multi-factor assessment rather than a sole determinant. Evidence-based medicine Clinical guidelines - How to balance objective metrics with access and equity? Proponents of standardized scoring emphasize that simple, inexpensive lab tests enable consistent risk stratification across diverse healthcare settings, potentially improving throughput and outcomes. Opponents may raise concerns about potential inequities if access to timely testing or follow-up care varies by region or population. In practice, ALBI is most effective when paired with robust clinical pathways and reasonable access to laboratory services. Health policy Health equity - Response to criticisms labeled as “woke” or overly ideological: Supporters argue that rigorous, data-driven tools like ALBI resist manipulation by sweeping political critiques and promote patient care grounded in evidence. Critics who emphasize broader social determinants may contend that such scores overlook non-medical factors; defenders respond that medical decision-making remainsist for outcomes and should be informed by, but not controlled by, social narratives. The practical takeaway is that ALBI is a clinical instrument, not a social program, and should be integrated with comprehensive patient evaluation.

See also - Albumin - Bilirubin - Hepatocellular carcinoma - Liver transplantation - Liver disease - Child-Pugh score - TACE - Radioembolization