ALBI Grade Calculator (Albumin-Bilirubin)
ALBI Grade Calculator (Albumin-Bilirubin)
Grade liver function from albumin and bilirubin alone — an objective alternative to Child-Pugh with no subjective components.
ALBI Grade (Albumin-Bilirubin)
Albumin + bilirubinBilirubin 30 µmol/L, albumin 34 g/L
Formula
- bilirubin
- µmol/L — multiply mg/dL by 17.1
- albumin
- g/L — multiply g/dL by 10
- log₁₀
- base-10 logarithm
- grades
- 1 ≤ −2.60 · 2 from −2.60 to −1.39 · 3 > −1.39
Worked example
Bilirubin 30 µmol/L, albumin 34 g/L
log₁₀(30) = 1.477
(0.66 × 1.477) − (0.085 × 34) = 0.975 − 2.890 = −1.92
Between −2.60 and −1.39 → grade 2
Grades
| ALBI score | Grade | Typical setting |
|---|---|---|
| ≤ −2.60 | 1 | Well-preserved function |
| > −2.60 to ≤ −1.39 | 2 | Intermediate |
| > −1.39 | 3 | Poor function |
Why ALBI was developed
Child-Pugh has two problems as a research and staging tool. Two of its five components — ascites and encephalopathy — are subjective and vary between observers, and its albumin and bilirubin thresholds were chosen empirically rather than derived. ALBI was built to replace it with something purely objective and statistically derived, using only two laboratory values.
It has been most widely adopted in hepatocellular carcinoma, where it separates outcomes within Child-Pugh A — a large and heterogeneous group in which most HCC treatment decisions are made. Two patients both classified Child-Pugh A can have quite different liver reserve, and ALBI distinguishes them, which matters when deciding between resection, ablation and systemic therapy.
Its limitations follow from its simplicity. Because it ignores ascites and encephalopathy it does not capture decompensation, so it is not a substitute for Child-Pugh when those complications are the clinical question. Albumin also falls in inflammation, nephrotic syndrome and malnutrition, so the score can overstate hepatic impairment in a septic or malnourished patient.
Frequently asked questions
What units does the ALBI score use?
Bilirubin in µmol/L and albumin in g/L. Multiply mg/dL bilirubin by 17.1 and g/dL albumin by 10 before calculating — using conventional units directly gives a nonsensical result.
What are the ALBI grade cut-offs?
Grade 1 is a score of −2.60 or below, grade 2 above −2.60 up to −1.39, and grade 3 above −1.39. More negative means better liver function.
Is ALBI better than Child-Pugh?
It is more objective and separates outcomes within Child-Pugh A, which is useful in hepatocellular carcinoma. It does not capture ascites or encephalopathy, so it does not replace Child-Pugh where decompensation is the question.
Can ALBI be used outside liver cancer?
It has been validated in a range of settings including alcohol-related hepatitis, acute-on-chronic liver failure and surgical risk assessment, though its evidence base is deepest in hepatocellular carcinoma.
Related calculators
References
- Johnson PJ et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach — the ALBI grade. J Clin Oncol. 2015;33(6):550–8.
- Toyoda H, Johnson PJ. The ALBI score: from liver function in patients with HCC to a general measure of liver function. JHEP Rep. 2022.