Preoperative Albumin-Bilirubin Score as a Predictor of Postoperative Complications After Liver Resection

Hepatic resection is an important curative procedure for both benign and malignant liver diseases, and the risks associated with liver resection, especially posthepatectomy liver failure (PHLF), are still a major concern. This is the reason why it is clear that the correct evaluation of hepatic functional reserve is imperative before surgery. The conventional scoring systems, like Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP), are less effective in predicting postoperative morbidity. An objective, inexpensive method, the albumin-bilirubin (ALBI) score, involving serum albumin and bilirubin, can be helpful in a resource-limited setting.

The objective of this study was to determine the preoperative ALBI score for predicting postoperative complications of patients undergoing hepatic resection.

This is a prospective observational study carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery (HBLT) of Bangabandhu Sheikh Mujib Medical University (now Bangladesh Medical University (BMU)), Dhaka, from August 2023 till July 2024. The number of adult patients who underwent liver resection and met the inclusion criteria was 70, who were sampled purposively. All of the demographic, laboratory, clinical, and operative data were documented preoperatively. Presurgery scores for ALBI, CTP, and MELD were calculated. The postoperative complications were assessed within 30 days. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 23, and receiver operating characteristic curve (ROC) analysis was used to assess the predictive accuracy of ALBI.

Out of 70 patients, 30 patients (42.9%) had postoperative complications. Patients with postoperative complications were significantly older than those without complications (50.67 ± 7.06 vs. 44.68 ± 10.26 years; P = 0.005). Biochemical parameters such as serum albumin were significantly decreased in the patients with complications. Liver failure after liver resection was significantly more common with an increase in the ALBI grade and did not occur in ALBI-1 (0.0%); there were 38.5% in ALBI-2 and 100% in ALBI-3. The ALBI score was significantly different between complication and non-complication groups, while the MELD score did not differ significantly between groups, whereas the CTP class showed a statistically significant difference. ALBI score showed weak-to-moderate predictive ability with area under the curve (AUC) 0.659, sensitivity 70.0%, and specificity 62.5% at a cut-off of -2.67 and in binary logistic regression analysis, age and ALBI score were independently associated with postoperative complications.

Preoperative ALBI score was significantly associated with postoperative complications and showed weak-to-moderate discriminatory ability. ALBI as having weak-to-moderate discriminatory ability and as a possible adjunctive marker, not a strong predictive test or replacement for clinical judgment and established scoring systems, but larger multicenter studies are needed to validate its cut-off and clinical usefulness.