{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T07:08:16Z","timestamp":1781334496003,"version":"3.54.1"},"reference-count":35,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T00:00:00Z","timestamp":1566172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Albumin\u2013bilirubin (ALBI) grade is defined using the ALBI score, which is calculated based on total serum bilirubin and albumin. This study aimed to evaluate the diagnostic ability of the ALBI score for determining hepatic fibrosis stage and transplant-free survival in primary biliary cholangitis (PBC) patients. A total of 181 Japanese patients with biopsy-proven or serologically diagnosed PBC were enrolled. The pathological stage was assessed using the Scheuer classification. The ALBI score differentiated fibrosis in stage 4 from that of 3 in the biopsy-proven cohort (p &lt; 0.05). With an ALBI score cut-off value of \u22121.679, the sensitivity and specificity were 100% and 91.1%, respectively, with a likelihood ratio of 12.3 to differentiate stage 4 from stages 1\u20133. The ALBI score at the beginning of ursodeoxycholic acid (UDCA) prescription correlated with the two prognostic scores calculated after 1-year UDCA treatment. Kaplan\u2013Meier analysis showed that the baseline ALBI score differentiated liver transplant-free survival (p &lt; 0.05). The ALBI score presented a greater hazard ratio for transplant-free survival than aspartate aminotransferase-to-platelet ratio index (APRI) in Cox proportional hazard model. In conclusion, ALBI score indicates pathological stage in Japanese PBC patients and scores before UDCA prescription predict better liver transplant-free survival, which correlated well with the two major prognostic scores. The prognosis-predicting ability of the ALBI score might surpass that of APRI.<\/jats:p>","DOI":"10.3390\/jcm8081258","type":"journal-article","created":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T11:22:38Z","timestamp":1566213758000},"page":"1258","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Prediction of Transplant-Free Survival through Albumin-Bilirubin Score in Primary Biliary Cholangitis"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9390-7565","authenticated-orcid":false,"given":"Koji","family":"Fujita","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9307-8808","authenticated-orcid":false,"given":"Takako","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-3045","authenticated-orcid":false,"given":"Asahiro","family":"Morishita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9531-7240","authenticated-orcid":false,"given":"Kyoko","family":"Oura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8801-2505","authenticated-orcid":false,"given":"Joji","family":"Tani","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Kobara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiko","family":"Tsutsui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Himoto","sequence":"additional","affiliation":[{"name":"Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu 761-0123, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsutomu","family":"Masaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki 761-0701, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2017). EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J. Hepatol., 67, 145\u2013172.","DOI":"10.1016\/j.jhep.2017.03.022"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1136\/gutjnl-2017-315259","article-title":"The British Society of Gastroenterology\/UK-PBC primary biliary cholangitis treatment and management guidelines","volume":"67","author":"Hirschfield","year":"2018","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/TP.0000000000002501","article-title":"Characteristics and Outcomes of Liver Transplantation for Primary Biliary Cholangitis (PBC) in Young patients: Analysis of the United Network for Organ Sharing Database","volume":"103","author":"Singh","year":"2019","journal-title":"Transplantation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1056\/NEJM199105303242204","article-title":"A multicenter, controlled trial of ursodiol for the treatment of primary biliary cirrhosis. UDCA-PBC Study Group","volume":"324","author":"Poupon","year":"1991","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1056\/NEJM199405123301903","article-title":"Ursodiol for the long-term treatment of primary biliary cirrhosis. The UDCA-PBC Study Group","volume":"330","author":"Poupon","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1053\/j.gastro.2005.12.029","article-title":"Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic Acid","volume":"130","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1111\/j.1572-0241.2006.00699.x","article-title":"Prognosis of ursodeoxycholic Acid-treated patients with primary biliary cirrhosis. Results of a 10-yr cohort study involving 297 patients","volume":"101","author":"Schalm","year":"2006","journal-title":"Am. J. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1016\/j.jhep.2014.01.029","article-title":"Optimising risk stratification in primary biliary cirrhosis: AST\/platelet ratio index predicts outcome independent of ursodeoxycholic acid response","volume":"60","author":"Trivedi","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/hepr.13291","article-title":"Changes in serum levels of leucine-rich \u03b12-glycoprotein predict prognosis in primary biliary cholangitis","volume":"49","author":"Hayashi","year":"2019","journal-title":"Hepatol. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1053\/j.gastro.2015.07.061","article-title":"Development and Validation of a Scoring System to Predict Outcomes of Patients With Primary Biliary Cirrhosis Receiving Ursodeoxycholic Acid Therapy","volume":"149","author":"Lammers","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1002\/hep.28017","article-title":"The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis","volume":"63","author":"Carbone","year":"2016","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1200\/JCO.2014.57.9151","article-title":"Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade","volume":"33","author":"Johnson","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects","volume":"310","author":"Association","year":"2013","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Vellinga, A., Cormican, M., Hanahoe, B., Bennett, K., and Murphy, A.W. (2011). Opt-out as an acceptable method of obtaining consent in medical research: A short report. BMC Med. Res. Methodol., 11.","DOI":"10.1186\/1471-2288-11-40"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"h6895","DOI":"10.1136\/bmj.h6895","article-title":"Patient choice in opt-in, active choice, and opt-out HIV screening: Randomized clinical trial","volume":"532","author":"Montoy","year":"2016","journal-title":"BMJ"},{"key":"ref_16","first-page":"47","article-title":"Molecular biology of the 2-oxo-acid dehydrogenase complexes and anti-mitochondrial antibodies","volume":"10","author":"Gershwin","year":"1992","journal-title":"Prog. Liver Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1002\/hep.21472","article-title":"Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis","volume":"45","author":"Nakamura","year":"2007","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1111\/apt.13927","article-title":"The risk predictive values of UK-PBC and GLOBE scoring system in Chinese patients with primary biliary cholangitis: The additional effect of anti-gp210","volume":"45","author":"Yang","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1053\/jhep.2003.50346","article-title":"A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C","volume":"38","author":"Wai","year":"2003","journal-title":"Hepatology"},{"key":"ref_20","first-page":"1257","article-title":"Primary biliary cirrhosis","volume":"60","author":"Scheuer","year":"1967","journal-title":"Proc. R. Soc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S0025-6196(11)63652-5","article-title":"Ludwig Symposium on biliary disorders\u2014Part II. Pathologic features and evolution of primary biliary cirrhosis and primary sclerosing cholangitis","volume":"73","author":"Scheuer","year":"1998","journal-title":"Mayo Clin. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1053\/he.2000.5852","article-title":"A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts","volume":"31","author":"Malinchoc","year":"2000","journal-title":"Hepatology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end-stage liver disease","volume":"33","author":"Kamath","year":"2001","journal-title":"Hepatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2502","DOI":"10.1002\/sim.2559","article-title":"Model selection for incomplete and design-based samples","volume":"25","author":"Hens","year":"2006","journal-title":"Stat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transpl."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fujita, K., Oura, K., Yoneyama, H., Ting Ting, S., Takuma, K., Nakahara, M., Tadokoro, T., Nomura, T., Morishita, A., and Tsutsui, K. (2019). Albumin-bilirubin score indicates liver fibrosis staging and prognosis in chronic hepatitis C patients. Hepatol. Res.","DOI":"10.1111\/hepr.13333"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12957-018-1500-9","article-title":"Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC","volume":"16","author":"Zhang","year":"2018","journal-title":"World J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1038\/bjc.2016.33","article-title":"Long-term impact of liver function on curative therapy for hepatocellular carcinoma: Application of the ALBI grade","volume":"114","author":"Toyoda","year":"2016","journal-title":"Br. J. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s10637-015-0292-9","article-title":"Liver function assessment according to the Albumin-Bilirubin (ALBI) grade in sorafenib-treated patients with advanced hepatocellular carcinoma","volume":"33","author":"Ogasawara","year":"2015","journal-title":"Investig. New Drugs"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1097\/COC.0000000000000384","article-title":"Assessment of the Albumin-Bilirubin (ALBI) Grade as a Prognostic Indicator for Hepatocellular Carcinoma Patients Treated with Radioembolization","volume":"41","author":"Gui","year":"2018","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Carling, U., R\u00f8sok, B., Line, P.D., and Dorenberg, E.J. (2018). ALBI and P-ALBI grade in Child-Pugh A patients treated with drug eluting embolic chemoembolization for hepatocellular carcinoma. Acta Radiol.","DOI":"10.1177\/0284185118799519"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1111\/jgh.12938","article-title":"New simple prognostic score for primary biliary cirrhosis: Albumin-bilirubin score","volume":"30","author":"Chan","year":"2015","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_33","unstructured":"Guilford, J.P. (1956). Fundamental Statistics in Psychology and Education, McGraw-Hill."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"126","DOI":"10.5604\/01.3001.0012.7904","article-title":"ALBI and PALBI Grades Are Associated with the Outcome of Patients with Stable Decompensated Cirrhosis","volume":"18","author":"Oikonomou","year":"2019","journal-title":"Ann. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1097\/MEG.0000000000000637","article-title":"The relationship between liver histology and noninvasive markers in primary biliary cirrhosis","volume":"28","author":"Olmez","year":"2016","journal-title":"Eur. J. Gastroenterol. Hepatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/8\/1258\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:12:15Z","timestamp":1760188335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/8\/1258"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,19]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["jcm8081258"],"URL":"https:\/\/doi.org\/10.3390\/jcm8081258","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,19]]}}}