❤️

ALBI Grade Calculator (Albumin-Bilirubin Score)

Calculate the albumin-bilirubin (ALBI) score and grade 1, 2 or 3 for liver function in hepatocellular carcinoma and chronic liver disease, from serum albumin and bilirubin in US or SI units.

Lab units

Total bilirubin

Albumin

Loading calculator…

How it works

ALBI = 0.66 × log₁₀(bilirubin, µmol/L) − 0.085 × albumin (g/L). Grade 1: ≤ −2.60 · Grade 2: > −2.60 to ≤ −1.39 · Grade 3: > −1.39. (Bilirubin mg/dL × 17.1 = µmol/L; albumin g/dL × 10 = g/L.)

The ALBI grade (Johnson et al., Journal of Clinical Oncology 2015) was developed in hepatocellular carcinoma as an objective alternative to Child-Pugh, using only two lab values and no subjective items such as ascites or encephalopathy. Grade 1 has the best survival and grade 3 the worst, and ALBI separates patients within Child-Pugh class A into groups with different outcomes. It is now used in HCC staging discussions, treatment selection (resection, TACE, systemic therapy) and liver disease research.

Worked example

Bilirubin 1.2 mg/dL (20.5 µmol/L) and albumin 3.5 g/dL (35 g/L): ALBI = 0.66 × log₁₀(20.52) − 0.085 × 35 = 0.866 − 2.975 = -2.11 → grade 2 (intermediate liver function).

Sources: Johnson PJ et al. Assessment of liver function in patients with hepatocellular carcinoma: the ALBI grade. J Clin Oncol 2015

Frequently asked questions

What do ALBI grades 1, 2 and 3 mean?

Grade 1 (score ≤ −2.60) is the best-preserved liver function, grade 2 (−2.60 to −1.39) intermediate and grade 3 (above −1.39) the most impaired, with the shortest survival in the original cohorts.

Why is the ALBI score negative?

Because the albumin term (−0.085 × g/L) is larger than the bilirubin term in most patients. More negative is better.

ALBI vs Child-Pugh — which is better?

ALBI is fully objective and splits Child-Pugh A patients into different risk groups, but Child-Pugh still captures ascites and encephalopathy. Many clinicians report both.

Can ALBI be used outside liver cancer?

It has been studied in cirrhosis, primary biliary cholangitis and drug-induced liver injury, but it was validated first in hepatocellular carcinoma.

Related calculators

Child-Pugh Score Calculator (Cirrhosis Severity)

Child-Pugh class A, B or C from bilirubin, albumin, INR, ascites and encephalopathy — one- and two-year survival, operative mortality and drug-dosing implications in cirrhosis.

MELD Score Calculator (Simplified)

Calculate the MELD 3.0 score used for US liver-transplant allocation since July 2023 (OPTN), plus MELD-Na and the original MELD, from bilirubin, INR, creatinine, sodium, albumin, sex and dialysis — with lab bounds applied, estimated 90-day survival, mortality bands and a term-by-term breakdown.

FIB-4 Index Calculator

Estimate liver fibrosis risk with the non-invasive FIB-4 index from age, AST, ALT and platelet count — a first-line screen before elastography or biopsy.

APRI Score Calculator (AST to Platelet Ratio Index)

Non-invasive liver fibrosis estimate with the APRI score — AST relative to its upper limit of normal divided by platelet count — with cut-offs for significant fibrosis and cirrhosis in hepatitis C, hepatitis B and fatty liver.

Clinical decision tool for education and for use by trained clinicians alongside clinical judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.