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Integrated routine laboratory indices for risk stratification in HBV-related cirrhosis: a real-world study
Lin Zhang1, Liang Li2, Xiaowei Du1
1Department of Infectious Diseases, Jiangsu Province (Suqian) Hospital, Suqian, Jiangsu Province, China.
Insights
A new risk stratification framework combining albumin-bilirubin (ALBI) score, fibrosis-4 (FIB-4) index, and prognostic nutritional index (PNI) effectively stages chronic hepatitis B (CHB) liver disease. This integrated approach improves risk assessment for hospitalized patients.
Area of Science:
- Hepatology
- Clinical Biochemistry
- Non-invasive Diagnostics
Background:
- Chronic hepatitis B (CHB) causes progressive liver damage, including dysfunction and fibrosis.
- Current non-invasive markers like albumin-bilirubin (ALBI) score, fibrosis-4 (FIB-4) index, and prognostic nutritional index (PNI) lack integrated staging value.
- The clinical utility of combining these indices for HBV-related liver disease risk stratification needs clarification.
Purpose of the Study:
- To develop and validate a non-invasive risk stratification framework using ALBI, FIB-4, and PNI.
- To evaluate the framework's performance across different clinical stages of HBV-related liver disease.
- To assess the framework's utility in hospitalized patient populations.
Main Methods:
- A retrospective cross-sectional study of 842 hospitalized patients with HBV-related liver disease.
- Categorization into chronic hepatitis B, compensated cirrhosis, and decompensated cirrhosis.
- Calculation of ALBI, FIB-4, and PNI from routine laboratory data; ordinal logistic regression and ROC analysis for performance evaluation.
Main Results:
- ALBI and FIB-4 scores increased with disease severity, while PNI decreased (P < 0.001).
- Age, ALBI, and FIB-4 were independent predictors of advanced stage; PNI and platelet count showed inverse association.
- The combined framework, enhanced by prothrombin time (PT), demonstrated superior discrimination for disease staging compared to individual markers.
Conclusions:
- An integrated framework of ALBI, FIB-4, PNI, and PT offers a simple, interpretable, and cost-effective tool for stage-based risk stratification in CHB.
- This tool is particularly valuable for hospitalized patients with HBV-related liver disease.
- Higher ALBI values were linked to hepatic encephalopathy in decompensated cirrhosis patients.
Background:
Chronic hepatitis B (CHB) is characterized by progressive structural and functional liver impairment involving hepatic dysfunction, fibrosis accumulation, and nutritional-immune imbalance. Although non-invasive indices derived from routine laboratory parameters-such as the albumin-bilirubin (ALBI) score, fibrosis-4 (FIB-4) index, and prognostic nutritional index (PNI)-are widely used, their integrated value for stage-based risk stratification in HBV-related liver disease remains unclear.
Aims:
To develop and internally validate a clinically applicable, non-invasive risk stratification framework based on ALBI, FIB-4, and PNI, and to evaluate its performance across different clinical stages of HBV-related liver disease.
Methods:
We conducted a single-center retrospective cross-sectional study including 842 hospitalized patients with HBV-related liver disease. Patients were categorized as chronic hepatitis B, compensated cirrhosis, or decompensated cirrhosis at admission. ALBI, FIB-4, and PNI were calculated from routine laboratory data. Ordinal logistic regression was used to identify factors associated with advanced disease stage. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, and calibration was evaluated. Factors associated with hepatic encephalopathy were explored in patients with decompensated cirrhosis.
Results:
ALBI and FIB-4 increased with higher disease stage, whereas PNI declined significantly (all P < 0.001). Multivariable analysis identified age, ALBI, and FIB-4 as independent factors associated with advanced stage, while PNI and platelet count were inversely associated. The combined framework was associated with improved discrimination for disease stages compared with individual indices, with further enhancement after incorporation of prothrombin time (PT). Higher ALBI values were independently associated with hepatic encephalopathy among patients with decompensated cirrhosis.
Conclusions:
An integrated framework combining ALBI, FIB-4, PNI, and PT may provide a simple, interpretable, and cost-accessible tool for stage-based risk stratification in HBV-related liver disease within hospitalized populations.
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