Prognostic utility of albumin-bilirubin grade in Japanese patients with primary biliary cholangitis

Yuki Yamashita; Takeji Umemura; Takefumi Kimura; Satoru Joshita; Junko Hirohara; Toshiaki Nakano; Atsumasa Komori; Atsushi Tanaka

doi:10.1016/j.jhepr.2022.100662

Prognostic utility of albumin-bilirubin grade in Japanese patients with primary biliary cholangitis

JHEP Rep. 2022 Dec 24;5(4):100662. doi: 10.1016/j.jhepr.2022.100662. eCollection 2023 Apr.

Authors

Yuki Yamashita¹, Takeji Umemura^{1

2}, Takefumi Kimura¹, Satoru Joshita¹, Junko Hirohara³, Toshiaki Nakano³, Atsumasa Komori⁴, Atsushi Tanaka⁵

Affiliations

¹ Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan.
² Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan.
³ The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
⁴ Clinical Research Center, National Hospital Organization (NHO) Nagasaki Medical Center, Nagasaki, Japan.
⁵ Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.

Abstract

Background & aims: The albumin-bilirubin (ALBI) score is calculated using serum levels of total bilirubin and albumin as a simple method to assess liver function. This study investigated the ability of baseline ALBI score/grade measurements to assess histological stage and disease progression in individuals with primary biliary cholangitis (PBC) in a large Japanese nationwide cohort.

Methods: A total of 8,768 Japanese patients with PBC were enrolled between 1980 and 2016 from 469 institutions, among whom 83% received ursodeoxycholic acid (UDCA) only, 9% received UDCA and bezafibrate, and 8% were given neither drug. Baseline clinical and laboratory parameters were retrospectively retrieved and reviewed from a central database. Associations of ALBI score/grade with histological stage, mortality, and need for liver transplantation (LT) were evaluated using Cox proportional hazards models.

Results: During the median follow-up period of 5.3 years, 1,227 patients died (including 789 from liver-related causes) and 113 underwent LT. ALBI score and ALBI grade were significantly associated with Scheuer's classification (both p <0.0001). ALBI grade 2 or 3 had significant associations with all-cause mortality or need for LT as well as liver-related mortality or need for LT according to Cox proportional hazards regression analysis (hazard ratio 3.453, 95% CI 2.942-4.052 and hazard ratio 4.242, 95% CI 3.421-5.260, respectively; both p <0.0001). Cumulative LT-free survival rates at 5 years in the ALBI grade 1, 2, and 3 groups were 97.2%, 82.4%, and 38.8%, respectively, while respective non-liver-related survival rates were 98.1%, 86.0%, and 42.0% (both p <0.0001, log-rank test).

Conclusions: This large nationwide study of patients with PBC suggested that baseline measurements of ALBI grade were a simple non-invasive predictor of prognosis in PBC.

Impact and implications: Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by progressive destruction of intrahepatic bile ducts. This study examined the ability of albumin-bilirubin (ALBI) score/grade to estimate histological findings and disease progression in PBC by means of a large-scale nationwide cohort in Japan. ALBI score/grade were significantly associated with Scheuer's classification stage. Baseline ALBI grade measurements may be a simple non-invasive predictor of prognosis in PBC.

Keywords: ALBI, albumin-bilirubin; ALP, alkaline phosphatase; AMA, anti-mitochondrial autoantibody; AUC, area under the ROC curve; BZF, bezafibrate; HR, hazard ratio; LSM, liver stiffness measurement; LT, liver transplantation; M2BPGi, Mac-2-binding protein glycosylation isomer; PBC, primary biliary cholangitis; Prognosis; ROC, receiver-operating characteristic; Transplantation; UDCA, ursodeoxycholic acid; ULN, upper limit of normal; Ursodeoxycholic acid; pc, corrected p.