If bilirubin in mg/dL: multiply by 17.1 to convert to μmol/L before applying formula. Both variables are objective laboratory values — no subjective clinical assessment required.
| Grade | ALBI Range | Liver Function | Clinical Implication |
|---|---|---|---|
| Grade 1 | ≤ −2.60 | Well-compensated | Curative therapies appropriate |
| Grade 2 | −2.60 to −1.39 | Moderate dysfunction | Select therapies with caution |
| Grade 3 | > −1.39 | Significant dysfunction | Systemic/palliative approach |
The ALBI score was developed and validated by Johnson et al. (2015) as an objective, evidence-based alternative to the Child-Pugh score for assessing liver function in patients with hepatocellular carcinoma (HCC). The score uses only two routine laboratory parameters — serum bilirubin and albumin — both of which are continuous, objective variables free from the interobserver variability inherent in clinical assessments of ascites and encephalopathy.
In HCC treatment selection, ALBI grade is used alongside tumour staging systems (BCLC, Barcelona Clinic Liver Cancer) to determine patient suitability for curative resection, transplantation, ablation, transarterial chemoembolisation (TACE), or systemic therapy. Grade 1 patients with preserved liver function tolerate aggressive therapies well, while Grade 3 patients carry substantial risk of hepatic decompensation even with minimally invasive interventions.
The score has been validated in cohorts exceeding 1,000 HCC patients across multiple continents, including Western, Asian, and mixed populations. It demonstrates superior discriminative ability for survival compared to Child-Pugh class in numerous studies, particularly in distinguishing outcomes within Child-Pugh class A — a group previously considered homogeneous.
The Child-Pugh score, while widely used, incorporates subjective assessments (ascites grade, hepatic encephalopathy grade) that introduce significant interobserver variability. The ALBI score addresses these limitations with a fully objective approach. Key advantages of ALBI over Child-Pugh include:
Despite these advantages, ALBI has not entirely replaced Child-Pugh in clinical practice. Child-Pugh remains important for assessing patients with clinically overt ascites or encephalopathy, and many international guidelines and trial eligibility criteria continue to use Child-Pugh class A/B as an entry criterion.