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ALBI (Albumin-Bilirubin) Grade for Hepatocellular Carcinoma (HCC)

Objective liver-function grading for HCC using only albumin and bilirubin.

ALBI (Albumin-Bilirubin) Grade for Hepatocellular Carcinoma (HCC)
Total bilirubin
mg/dL
Serum albumin
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When to use

  • Grading underlying liver function in HCC without needing subjective variables (ascites, encephalopathy) used by Child-Pugh.

Formula

ALBI = (log10[bilirubin, umol/L] x 0.66) + (albumin[g/L] x -0.0852); mg/dL bilirubin x 17.1 = umol/L. Grade 1: <=-2.60; Grade 2: >-2.60 to <=-1.39; Grade 3: >-1.39.

Pearls and pitfalls

  • Developed as an objective, reproducible alternative to Child-Pugh grade for stratifying survival in HCC.
  • Increasingly used to help select candidates for resection, ablation, and systemic therapy.

References

  1. Johnson PJ, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550-8.