Platelet-Albumin-Bilirubin Score Predicts In-Hospital Mortality in Patients with HFrEF Presenting with Acute Heart...

Patients with heart failure and reduced ejection fraction presenting with acute heart failure (HFrEF-AHF) carry a high in-hospital mortality. Conventional predictors do not fully capture the interplay between hepatic dysfunction, systemic inflammation, and nutritional decline. The platelet-albumin-bilirubin (PALBI) score, originally developed in hepatology, may offer incremental prognostic information in this setting.

A total of 401 patients hospitalized with HFrEF-AHF were retrospectively studied. Baseline demographic, clinical, and laboratory data were collected. Platelet-albumin-bilirubin and albumin-bilirubin (ALBI) scores were calculated. The primary endpoint was all-cause in-hospital mortality.

In-hospital mortality occurred in 47 patients (11.7%). Non-survivors were older, more frequently had chronic kidney disease (CKD), and showed lower albumin but higher bilirubin and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Both PALBI and ALBI were significantly higher in non-survivors. In multivariable Cox analysis, PALBI independently predicted mortality (hazard ratio = 2.638, 95% CI: 1.177-4.099, P < .001), along with age, CKD, and NT-proBNP. Receiver operating characteristic analysis showed that PALBI demonstrated slightly better performance than conventional predictors and, compared with ALBI (area under the curve = 0.737 vs. 0.708), yielded a modest but significant net reclassification improvement (~10%). Kaplan-Meier curves demonstrated clear separation in survival across PALBI strata (log-rank, P < .001), and restricted cubic spline analysis confirmed a graded, continuous association with risk.

The PALBI score independently predicts in-hospital mortality in patients with HFrEF-AHF and may represent a simple and clinically useful tool for early risk stratification. External validation in larger, multicenter cohorts is warranted.