Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery

ABSTRACT Introduction: The heart and liver are two organs that are closely related. The Albumin-Bilirubin (ALBI) score is a developed scoring system for assessing liver function. The aims of this study were to examine the correlation between preoperative ALBI score and pulmonary artery pressure and to investigate its ability to predict heart valve surgery mortality outcomes. Methods: The data of 872 patients who underwent isolated and combined heart valve surgery from 2014 to 2021 were retrospectively screened. In the preoperative period, 152 patients with laboratory tests including albumin and total bilirubin were found and analyzed retrospectively. Thirteen of these patients were excluded from the study. The remaining 139 patients were included in the analysis. Baseline demographic data, echocardiography data, performance status, laboratory data, operative data, and postoperative status were collected. The optimal cutoff value of preoperative ALBI score was calculated. Results: The cutoff for ALBI scores was calculated as -2.44 to predict in-hospital mortality (sensitivity = 75.0%, specificity = 70%). Based on the cutoff value, 90 patients had a low ALBI score (≤ -2.44, 64.7%) and 49 patients had a high ALBI score (> -2.44, 35.3%). High ALBI score was associated with an increased incidence of acute kidney injury and in-hospital mortality, and a positive correlation was found between ALBI score and pulmonary artery pressure. Conclusion: In patients with valvular surgery, high ALBI score was an independent prognostic factor of in-hospital mortality and acute kidney injury. It is easily measurable and a cost-effective way to predict mortality.

摘要
引言：心脏与肝脏是两类密切关联的器官。白蛋白-胆红素（Albumin-Bilirubin, ALBI）评分是一套用于评估肝功能的成熟评分系统。本研究旨在探讨术前ALBI评分与肺动脉压的相关性，并分析其对心脏瓣膜手术患者术后院内死亡结局的预测能力。

方法：本研究回顾性筛选了2014年至2021年间接受单纯及复合心脏瓣膜手术的872例患者的临床资料。其中，152例术前完成白蛋白与总胆红素实验室检测的患者被纳入回顾性分析，最终13例患者被排除，剩余139例患者进入最终分析环节。研究收集了患者的基线人口学资料、超声心动图数据、体能状态、实验室检测结果、手术相关数据及术后转归情况，并计算了术前ALBI评分的最佳截断值。

结果：用于预测院内死亡的ALBI评分最佳截断值为-2.44，灵敏度为75.0%，特异度为70%。依据该截断值，90例患者ALBI评分较低（≤-2.44，占比64.7%），49例患者评分较高（＞-2.44，占比35.3%）。高ALBI评分与急性肾损伤发生率及院内死亡率升高显著相关，且ALBI评分与肺动脉压呈正相关。

结论：在心脏瓣膜手术患者中，高ALBI评分是院内死亡及急性肾损伤的独立预后因素。该评分检测便捷且具有成本效益，可用于预测患者术后死亡风险。