Albumin–Bilirubin Score Is Associated With Veno‐Occlusive Disease‐Related Mortality in Children Post‐Hematopoietic Stem Cell Transplant

BACKGROUND: Veno-occlusive disease (VOD) is a common complication post-hematopoietic stem cell transplant (HSCT) and is associated with increased mortality. Factors predictive of outcomes are lacking. Albumin-bilirubin (ALBI) score is used to quantify liver function and prognosticate but has not been investigated in VOD. METHODS: Single-center retrospective study investigating the ALBI score in children aged 0-26 years who underwent HSCT from 2019 to 2024 and developed VOD. Primary outcome was hospital mortality. ALBI score was calculated at time points chosen a priori spanning preconditioning to post-VOD diagnosis. RESULTS: Forty-three patients developed VOD. Most were transplanted for cancer (n = 33, 77%). Seven (16%) died. Preconditioning median ALBI scores did not differ between survivors and non-survivors. Median ALBI scores significantly increased from preconditioning -3.00 (IQR: -3.10, -2.80) to VOD diagnosis -1.70 (IQR: -2.00, -1.50), p < 0.001. In the week after VOD diagnosis, ALBI scores improved in survivors but worsened in non-survivors. ALBI scores 7 days post-VOD diagnosis were higher in non-survivors (p = 0.008, AUC = 0.83). Using an established cutoff, severe ALBI on day 7 post-VOD diagnosis had greater mortality odds (OR = 8.3 [95% CI: 1.4, 48.5], p = 0.02). Those who died trended toward higher ALBI 3 days prior to VOD diagnosis than those who survived, -1.70 (IQR: -1.90, -1.30) versus -2.10 (IQR: -2.40, -1.80), p = 0.16. CONCLUSIONS: In this cohort, ALBI score worsened with VOD diagnosis and at 7 days post-diagnosis was associated with mortality. The ALBI score is easily obtained and may aid in VOD prognostication.