Albumin–bilirubin score predicts in-hospital overt hepatic encephalopathy in cirrhosis: A Vietnamese prospective study

Overt hepatic encephalopathy (OHE) is a severe complication of liver cirrhosis, causing cognitive dysfunction and high mortality. Early prediction is vital for better management. The albumin-bilirubin (ALBI) score, a simple tool to assess liver function, has potential for OHE prediction but is understudied in hospitalized settings, especially in Vietnam, where liver disease burden is high, and resources are limited. This prospective cohort study included 159 cirrhotic patients admitted to Cho Ray Hospital, Ho Chi Minh City, Vietnam, from February to August 2022. Clinical and laboratory data, including ALBI, Child-Turcotte-Pugh, and model for end-stage liver disease scores, were recorded within 24 hours of admission. Patients were monitored daily for in-hospital OHE development based on ISHEN criteria. Predictive accuracy was evaluated using receiver operating characteristic curves. Of 159 patients, 42 (26.4%) developed OHE. The ALBI score demonstrated strong predictive accuracy (area under the curve [AUC] = 0.83, P < .001) with sensitivity of 95.2% and specificity of 47% at a cutoff of -1.42. Patients with ALBI ≥ -1.42 had a 17.74-fold increased risk of OHE. ALBI's performance was comparable to model for end-stage liver disease (AUC = 0.84, P = .76) and Child-Turcotte-Pugh (AUC = 0.82, P = .56). The ALBI score is a practical and effective tool for predicting in-hospital OHE in cirrhotic patients. Its simplicity, relying on readily available parameters, makes it particularly valuable in Vietnam's resource-constrained settings. Integration of the ALBI score into routine care could improve risk stratification and optimize healthcare resource allocation.