ALBI Score (Albumin-Bilirubin)

Objective prognostic assessment of liver function using serum albumin and bilirubin. Primarily validated in hepatocellular carcinoma (HCC) for stratifying prognosis and guiding treatment decisions.

Gastroenterology Internal MedicineEvidence-BasedUpdated 2026-08

Clinical Notes

Formula

ALBI = (log10(bilirubin [µmol/L]) × −0.372) + (albumin [g/L] × −0.198) + 4.90

Normal Range

Grade I (≤ −2.60)

Clinical Notes

The ALBI score was published by Johnson et al. in 2014 (J Clin Oncol 32:3378-3386) as an objective alternative to the Child-Pugh score for assessing liver function in HCC. Unlike Child-Pugh, ALBI uses only two objective laboratory values (albumin and bilirubin), eliminating the subjective components of ascites, encephalopathy, and nutritional status. ALBI has been validated in multiple international cohorts and is increasingly incorporated into HCC staging systems and treatment algorithms.

Calculator Information

Specialty

Internal Medicine

📋 Reference Ranges

Normal Range

Grade I (≤ −2.60)

Reference ranges for this calculator
Classification	Range
Grade I (best prognosis)	≤ −2.60
Grade II (intermediate prognosis)	−2.60 to −1.39
Grade III (worst prognosis)	> −1.39

What This Calculator Measures

Objective prognostic assessment of liver function using serum albumin and bilirubin. Primarily validated in hepatocellular carcinoma (HCC) for stratifying prognosis and guiding treatment decisions.

How to Use

Enter total bilirubin in µmol/L (multiply mg/dL by 17.1 to convert).
Enter serum albumin in g/L (multiply g/dL by 10 to convert).
The calculator computes the ALBI score and assigns a grade.
Grade I (≤ −2.60): Best prognosis. Consider curative therapies.
Grade II (−2.60 to −1.39): Intermediate prognosis. Multidisciplinary discussion.
Grade III (> −1.39): Worst prognosis. Consider systemic therapy or supportive care.

Interpretation Guide

ALBI Grade I indicates preserved liver function with favorable prognosis. Grade III indicates severe liver dysfunction with poor prognosis. ALBI is objective and reproducible, eliminating the subjective components of Child-Pugh scoring.

Clinical Significance

ALBI provides an objective, reproducible alternative to Child-Pugh for liver function assessment in HCC. It uses only two laboratory values and has been validated in multiple international cohorts, making it increasingly adopted in HCC staging systems.

When to Use

HCC patients for liver function assessment and prognosis stratification
When objective liver function assessment is preferred over Child-Pugh
For HCC treatment decision-making (curative vs. palliative intent)
For comparing liver function across patients or studies

When Not to Use

As a sole determinant for treatment decisions (must integrate tumor stage, performance status)
In non-HCC liver disease without additional validation
When portal hypertension complications (varices, ascites) need assessment (use Child-Pugh)

Limitations

Primarily validated in HCC patients; use in other liver diseases should be interpreted with caution.
Does not account for portal hypertension, encephalopathy, or other clinical features.
Extreme albumin or bilirubin values may produce less reliable results.
Does not replace comprehensive clinical assessment for treatment decisions.

Worked Example

An HCC patient with bilirubin 25 µmol/L and albumin 38 g/L.

Inputs:

bilirubin: 25

albumin: 38

ALBI = (log10(25) × −0.372) + (38 × −0.198) + 4.90 = (1.398 × −0.372) + (−7.524) + 4.90 = −0.520 + (−7.524) + 4.90 = −3.14 (Grade I — best prognosis).

Evidence

Source: Gastroenterology
Reference: Johnson PJ, et al. J Clin Oncol. 2015;33(6):550-558.
Reviewed By: MedCalcHub Clinical Team
Version: 1.0
Updated: 2026-08

Johnson PJ, et al. J Clin Oncol. 2015;33(6):550-558.
Hiraoka A, et al. Liver Cancer. 2017;6(2):112-119.

References

Johnson PJ, et al. J Clin Oncol. 2015;33(6):550-558. (Original validation)
Hiraoka A, et al. Liver Cancer. 2017;6(2):112-119. (Validation study)

Frequently Asked Questions

What is the ALBI score?

The ALBI (Albumin-Bilirubin) score is an objective prognostic tool for assessing liver function using only serum albumin and bilirubin. It was developed as a more reproducible alternative to the Child-Pugh score, eliminating subjective components like ascites and encephalopathy grading.

What are the ALBI grades?

ALBI Grade I (≤ −2.60): Best prognosis, ~25% 1-year mortality. ALBI Grade II (−2.60 to −1.39): Intermediate prognosis, ~50% 1-year mortality. ALBI Grade III (> −1.39): Worst prognosis, ~75% 1-year mortality. These were derived from HCC patient cohorts.

How does ALBI compare to Child-Pugh?

ALBI uses only two objective lab values (albumin and bilirubin), while Child-Pugh includes subjective components (ascites, encephalopathy, nutritional status). ALBI is more reproducible and has been shown to predict outcomes similarly or better than Child-Pugh in HCC patients.

Can ALBI be used for non-HCC liver disease?

ALBI was primarily validated in HCC patients. While it may provide useful prognostic information in other liver diseases (cirrhosis, hepatitis), its use outside HCC should be interpreted with caution as it has not been as extensively validated in these populations.

What units does the ALBI formula use?

The ALBI formula uses bilirubin in µmol/L (SI units; multiply mg/dL by 17.1 to convert) and albumin in g/L (multiply g/dL by 10 to convert).

Disclaimer: This calculator is intended for educational and clinical decision support. ALBI score should be used as part of comprehensive HCC assessment, not as a standalone tool for treatment decisions.