Predictive role of the Albumin-Bilirubin score in ICU patients with cirrhosis and sepsis: insights from a large retrospective cohort

Abstract

Background: The albumin-bilirubin (ALBI) score is a valuable prognostic tool for diseases such as hepatocellular carcinoma, heart failure, and acute kidney injury. However, its association with the prognosis of patients with liver cirrhosis and sepsis in the intensive care unit (ICU) remains unclear. Methods: This retrospective study analyzed data from ICU patients with liver cirrhosis and sepsis admitted to the Beth Israel Deaconess Medical Center between 2008 and 2022. The primary and secondary endpoints were 28-day (short-term) and 90-day (long-term) mortality, respectively. Relationships between mortality risk and the ALBI scores were assessed by Kaplan-Meier, multivariable Cox proportional hazard, and restricted cubic spline (RCS) analyses. The receiver operating characteristic (ROC) curves were used to evaluate the predictive ability of the ALBI score for 28-day and 90-day mortality in these patients. Subgroup analyses were used to explore the associations between the ALBI scores and different patient populations. Results: The study included 2,047 ICU patients with liver cirrhosis and sepsis. Patients with higher ALBI scores had significantly higher 28-day and 90-day mortality rates than those with lower scores (Kaplan-Meier). The ALBI score was an independent predictor of short-term and long-term mortality (multivariable Cox regression). In the fully adjusted model, the hazard ratios (HRs) for the ALBI score as a continuous variable were 1.38 (95% confidence interval [CI]: 1.20–1.58, P < 0.001) and 1.33 (95% CI: 1.18–1.50, P < 0.001) for 28-day and 90-day mortality, respectively. When categorized into tertiles, the mortality risk was significantly higher for patients in the highest tertile than for those in the lowest tertile, with HRs of 1.51 (95% CI: 1.23–1.85, P for trend < 0.001) and 1.45 (95% CI: 1.21–1.73, P for trend < 0.001) for 28-day and 90-day mortality, respectively. A nonlinear relationship was identified between the ALBI score and short- and long-term mortality (RCS analysis). The results of the ROC curve analysis confirmed that the predictive ability of the ALBI score for 28-day and 90-day mortality was not inferior to that of the Sequential Organ Failure Assessment score. Subgroup analyses showed that there were no significant interactions between ALBI scores and the vast majority of subgroups. Conclusions: Higher ALBI scores were significantly and independently associated with increased short- and long-term mortality in ICU patients with liver cirrhosis and sepsis. The ALBI score may help with risk and prognostic evaluations in this high-risk population.