Association between albumin-bilirubin score, model for end-stage liver disease score, platelet-albumin-bilirubin score, and acute-on-chronic liver failure complications: a cross-sectional study in a Chinese population.

Abstract

Background and aims: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation and high short-term mortality. We investigated whether the albumin-bilirubin (ALBI) score, model for end-stage liver disease (MELD) score, and platelet-albumin-bilirubin (PALBI) score independently predict major ACLF complications.

Methods: This retrospective cross-sectional study enrolled 2104 ACLF patients (2017-2024) fulfilling Asian Pacific Association for the Study of the Liver 2019 criteria. ALBI, MELD, and PALBI were calculated within 48 h of admission. Multivariable logistic regression, restricted cubic spline, and receiver operating characteristic (ROC) analyses assessed associations with ascites, hepatic encephalopathy, hepatorenal syndrome (HRS), coagulopathy, splenomegaly, and spontaneous bacterial peritonitis.

Results: All three scores increased significantly with worsening Child-Pugh class (P < 0.001). Per SD increase, ALBI predicted all six complications with adjusted odds ratios (ORs) ranging from 1.98 to 8.73. MELD showed similar predictive ability (ORs: 2.58-7.26). PALBI quartiles 2 and 3 remained significantly associated with HRS (P = 0.007 and P = 0.011, respectively). Restricted cubic spline revealed nonlinear dose-response relationships (P-nonlinearity < 0.005). ROC area under the curve values were consistently higher for MELD than ALBI and PALBI. Subgroup analyses confirmed stability across age, sex, BMI, smoking, and alcohol use.

Conclusion: ALBI, MELD, and PALBI scores simply and reliably identify ACLF complications, helping clinicians intensify monitoring and tailor therapy for high-risk patients.