This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
The ALBI grade (albumin-bilirubin) was published by Philip Johnson and colleagues in the Journal of Clinical Oncology in 2015. It was built from large international cohorts of patients with hepatocellular carcinoma, to measure liver function without the subjective parts of the Child-Pugh score: ascites and encephalopathy depend on the examiner and on treatment, while albumin and bilirubin are plain lab values.
The formula
ALBI = 0.66 × log10(bilirubin in µmol/L) − 0.085 × albumin in g/L
The equation works in SI units. If your lab reports bilirubin in mg/dL, multiply by 17.1; if it reports albumin in g/dL, multiply by 10. The calculator does this for you and shows the converted values.
The score is negative. The more negative it is, the better the liver works, because a high albumin pulls the result down and a high bilirubin pushes it up.
Grades
| ALBI score | Grade |
|---|---|
| −2.60 or less | Grade 1 |
| −2.60 to −1.39 | Grade 2 |
| above −1.39 | Grade 3 |
Grade 2 covers most patients, so Hiraoka and colleagues proposed the modified ALBI (mALBI), which splits it at −2.27 into 2a (−2.60 to −2.27) and 2b (−2.27 to −1.39). Grade 2b behaves closer to grade 3 in survival studies.
Example
Bilirubin 1.2 mg/dL (20.5 µmol/L) and albumin 3.5 g/dL (35 g/L):
0.66 × log10(20.5) − 0.085 × 35 = 0.866 − 2.975 = −2.11, grade 2, mALBI 2b.
Where ALBI is used
- Liver cancer: to compare liver reserve before resection, ablation, chemoembolization or systemic therapy, and to split Child-Pugh A patients into groups with different outcomes.
- Chronic liver disease: studies in primary biliary cholangitis, hepatitis and cirrhosis have used ALBI as an objective marker of function.
- Trials: it is easy to compute from routine blood tests at every visit.
Limits
Albumin falls with malnutrition, inflammation, kidney or gut losses and after albumin infusions, and bilirubin rises with hemolysis, Gilbert syndrome or biliary obstruction. These change the score without reflecting liver cell function. ALBI does not include the INR, so it should sit next to the Child-Pugh and MELD scores rather than replace them, and treatment decisions belong to the hepatology or oncology team.