Question 1

Does ALBI replace Child-Pugh in clinical practice?

Accepted Answer

ALBI is a complement, not a replacement. Child-Pugh remains widely used for perioperative risk assessment and prognostic stratification. ALBI offers superior objectivity and reproducibility, which is especially valuable in clinical trials and when comparing outcomes across centres.

Question 2

Is ALBI validated in non-cirrhotic liver disease?

Accepted Answer

ALBI was developed in HCC populations, most of whom had underlying cirrhosis. It has since been validated in acute-on-chronic liver failure, hepatitis B, and alcoholic hepatitis. Its utility in non-cirrhotic liver disease without synthetic dysfunction is limited.

Question 3

Can ALBI be used in patients without liver disease?

Accepted Answer

The ALBI grade was designed for patients with known or suspected liver impairment. In patients with normal liver function, the score will typically fall into grade 1. It has no established role in patients without liver pathology.

Question 4

What if bilirubin is elevated due to obstruction rather than hepatocellular dysfunction?

Accepted Answer

ALBI does not distinguish cholestatic from hepatocellular jaundice. In obstructive jaundice, the grade may overestimate hepatic impairment. Correlate with imaging (ultrasound, MRCP) and consider biliary drainage before interpreting the score as a measure of liver synthetic function.