Prognostic Accuracy of Albumin Bilirubin Score for Outcomes of In-Hospital Patients with Heart Failure

Abstract

Background: Hepatic congestion and hypoperfusion are integral to heart-failure (HF) pathophysiology and lead to hyper-bilirubinaemia and hypo-albuminaemia. The logarithmic Albumin–Bilirubin (ALBI) score, already validated in hepatology, may provide an inexpensive prognostic marker in HF, but data for acute, in-hospital outcomes remain sparse.

Objective: To compare the prognostic accuracy of ALBI with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and with a composite (ALBI + NT-proBNP) for predicting all-cause in-hospital mortality among adults admitted with acute HF.

Methods: In this 18-month prospective cohort at a tertiary centre in New Delhi (n = 100, Framingham criteria), serum albumin, total bilirubin and NT-proBNP were assayed within 24 h of admission; ALBI was calculated as −0.0852 × albumin (g L⁻¹) + 0.66 × log₁₀(bilirubin µmol L⁻¹). Primary end-point was in-hospital death. Discrimination was examined with ROC curves.

Results: Mean age 52.6 ± 16.4 y; 63 % male. Mortality occurred in 39 %. Median ALBI −2.20 (IQR −2.68 to −1.59). An ALBI threshold ≥ −2.08 yielded 90 % sensitivity and 79 % specificity; AUROC = 0.889 versus 0.776 for NT-proBNP (cut-off ≥ 10 242 pg mL⁻¹). The composite marker achieved AUROC = 0.929 (p = 0.001 vs NT-proBNP). Across HF phenotypes, ALBI ≥ −2.27 identified 93.5 % of deaths in HFrEF and 100 % in HFmrEF.

Conclusions: A single ALBI measurement on admission is non-inferior to NT-proBNP and markedly enhances prognostic accuracy when combined with NT-proBNP. Given its negligible cost and bedside availability, ALBI offers a practical risk-stratification tool, particularly where natriuretic-peptide assays are inaccessible.