What question did this study set out to answer?

This study aims to determine if ALBI, MELD, and PALBI scores predict major complications in ACLF patients.

June 26, 2026

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

Key Points

This study aims to determine if ALBI, MELD, and PALBI scores predict major complications in ACLF patients.
Cross-sectional design involving 2104 ACLF patients based on specific criteria.
Score calculations were performed within 48 hours of admission.
Multivariable logistic regression and ROC analyses were used to assess complications.
ALBI score predicted complications with adjusted ORs between 1.98 and 8.73 per SD increase.
MELD score showed similar predictive capacity with ORs ranging from 2.58 to 7.26.
ROCs indicated higher predictive accuracy for MELD compared to ALBI and PALBI.

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.

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