Wang Jianjun, Yang Pei, Qin Chuan, Huang Yongwei, Hu Zhaohui, Shi Ruizi, Chen Sirui, Chen Xi, Luo Hua, Gong Jianping, Zeng Xintao, Wang Decai
Department of Hepatobiliary Surgery, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
NHC Key Laboratory of Nuclear Technology Medical Transformation, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, China.
BMC Gastroenterol. 2025 Jul 15;25(1):520. doi: 10.1186/s12876-025-04111-7.
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.
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.
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, < 0.001) and 1.33 (95% CI: 1.18–1.50, < 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.
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.
The online version contains supplementary material available at 10.1186/s12876-025-04111-7.
白蛋白-胆红素（ALBI）评分是肝细胞癌、心力衰竭和急性肾损伤等疾病的一种有价值的预后评估工具。然而，其与重症监护病房（ICU）中肝硬化合并脓毒症患者预后的相关性仍不明确。
这项回顾性研究分析了2008年至2022年间入住贝斯以色列女执事医疗中心的肝硬化合并脓毒症ICU患者的数据。主要和次要终点分别为28天（短期）和90天（长期）死亡率。通过Kaplan-Meier分析、多变量Cox比例风险分析和限制性立方样条（RCS）分析评估死亡率风险与ALBI评分之间的关系。采用受试者工作特征（ROC）曲线评估ALBI评分对这些患者28天和90天死亡率的预测能力。进行亚组分析以探讨ALBI评分与不同患者群体之间的关联。
该研究纳入了2047例肝硬化合并脓毒症的ICU患者。ALBI评分较高的患者28天和90天死亡率显著高于评分较低的患者（Kaplan-Meier分析）。ALBI评分是短期和长期死亡率的独立预测因素（多变量Cox回归）。在完全调整模型中，作为连续变量的ALBI评分对于28天和90天死亡率的风险比（HR）分别为1.38（95%置信区间[CI]：1.20 - 1.58，P < 0.001）和1.33（95%CI：1.18 - 1.50，P < 0.001）。当分为三分位数时，最高三分位数患者的死亡风险显著高于最低三分位数患者，28天和90天死亡率的HR分别为1.51（95%CI：1.23 - 1.85，趋势P < 0.001）和1.45（95%CI：1.21 - 1.73，趋势P < 0.001）。在ALBI评分与短期和长期死亡率之间发现了非线性关系（RCS分析）。ROC曲线分析结果证实，ALBI评分对28天和90天死亡率的预测能力不低于序贯器官衰竭评估评分。亚组分析表明，ALBI评分与绝大多数亚组之间无显著交互作用。
较高的ALBI评分与肝硬化合并脓毒症ICU患者短期和长期死亡率的增加显著且独立相关。ALBI评分可能有助于对这一高危人群进行风险和预后评估。
在线版本包含可在10.1186/s12876 - 025 - 04111 - 7获取的补充材料。
