The Association of Albumin-Bilirubin (ALBI) Grade with Mortality Risk in Trauma Patients with Liver Injuries

Figures & data

Figure 1 Flow chart illustrating the participant selection process and characterization into albumin-bilirubin (ALBI) grade 1 to 3.

Table 1 Patient and Injury Characteristics Based on Mortality Outcomes in Patients with Traumatic Liver Injury

Variables	Death	Survival	OR (95% CI)	P
	n = 20	n = 239
Age, years	43.5±16.9	42.2±17.0	–	0.745
Male, n (%)	17(85.0)	136(56.9)	4.29(1.23–15.04)	0.014
Comorbidities
CAD, n (%)	2(10.0)	3(1.3)	8.74(1.37–55.72)	0.006
DM, n (%)	1(5.0)	19(7.9)	0.61(0.08–4.80)	0.635
ESRD, n (%)	1(5.0)	1(0.4)	12.53(0.75–208.25)	0.025
HTN, n (%)	6(30.0)	23(9.6)	4.03(1.41–11.49)	0.006
BMI	28.0±4.0	24.5±4.4	–	0.001
Mechanisms				0.560
Blunt, n (%)	20(100)	235(98.3)	–	–
Penetration, n (%)	0(0.0)	4(1.7)	–	–
Vital signs at ER
SBP, mmHg	108.7±38.4	122.1±32.2	–	0.081
Heart rate, beats/min	109.3±28.9	95.1±19.6	–	0.003
Respiration rate, times/min	21.0±4.7	19.6±3.6	–	0.117
Laboratory data
Albumin, g/dL	2.8±0.4	3.4±0.7	–	<0.001
Total bilirubin, mg/dL	1.1±0.6	1.0±0.7	–	0.628
GOT, U/L	689.0±1193.7	456.9±442.0	–	0.064
GPT, U/L	202.4±202.1	308.8±220.0	–	0.038
ALBI	2.8±0.4	3.4±0.7	–	<0.001
GCS, median (IQR)	8(3–13)	15(14–15)	–	<0.001
ISS, median (IQR)	33(24–40)	20(13–29)	–	<0.001
1–15, n (%)	2(10.0)	70(29.3)	0.27(0.06–1.19)	0.064
16–24, n (%)	3(15.0)	89(37.2)	0.30(0.09–1.04)	0.046
≥ 25, n (%)	15(75.0)	80(33.5)	5.96(2.09–16.99)	<0.001

Abbreviations: ALBI, albumin-bilirubin; BMI, body mass index; CAD, coronary artery disease; CI, confidence interval; DM, diabetes mellitus; ER, emergency room; ESRD, end-stage renal disease; GCS, Glasgow Coma Scale; GOT, glutamic oxaloacetic transaminase (aspartate aminotransferase); GPT, glutamic pyruvic transaminase (alanine aminotransferase); HTN, hypertension; IQR, interquartile range; ISS, injury severity score; OR, odds ratio; SBP, systolic blood pressure.

Table 2 Univariate and Multivariate Analysis to Identify the Risk Factors for Mortality in the Trauma Patients with Liver Injury

	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P	OR	95% CI	P
Male	4.29	(1.23–15.04)	0.014	5.19	(0.91–29.68)	0.064
CAD	8.74	(1.37–55.72)	0.006	0.86	(0.04–18.96)	0.925
ESRD	12.53	(0.75–208.25)	0.025	5.51	(0.71–30.17)	0.299
HTN	4.03	(1.41–11.49)	0.006	6.66	(1.00–44.23)	0.052
BMI	1.17	(1.06–1.29)	0.002	1.11	(0.97–1.27)	0.136
Heart rate	1.03	(1.01–1.05)	0.004	1.02	(1.01–1.06)	0.042
GCS	0.75	(0.68–0.84)	<0.001	0.82	(0.70–0.96)	0.016
ISS	1.08	(1.04–1.12)	<0.001	1.07	(1.03–1.12)	0.002
GPT	0.97	(0.94–1.00)	0.038	0.97	(0.97–0.99)	0.032
ALBI	3.29	(1.64–6.60)	<0.001	2.79	(1.27–8.05)	0.038

Abbreviations: ALBI, albumin-bilirubin; BMI, body mass index; CAD, coronary artery disease; CI, confidence interval; ESRD, end-stage renal disease; GCS, Glasgow Coma Scale; GPT, glutamic pyruvic transaminase (alanine aminotransferase); HTN, hypertension; ISS, injury severity score; OR, odds ratio.

Table 3 Outcomes and Characteristics of the Trauma Patients with Liver Injury According to ALBI Grade

Variables	Grade 1	Grade 2	Grade 3	P
	n = 50	n = 180	n = 29
Age, years	39.9±16.2	42.3±17.1	46.6±17.4	0.240
Male, n (%)	33(66.0)	99(55.0)	21(72.4)	0.113
Comorbidities
CAD, n (%)	0(0.0)	2(1.1)	3(10.3)*	0.002
DM, n (%)	3(6.0)	13(7.2)	4(13.8)	0.412
ESRD, n (%)	0(0.0)	1(0.6)	1(3.4)	0.201
HTN, n (%)	4(8.0)	19(10.6)	6(20.7)	0.200
Laboratory data
Albumin, g/dL	4.1±0.3	3.4±0.5*	2.2±0.5*	<0.001
Total bilirubin, mg/dL	0.7±0.5	1.1±0.6*	1.5±0.9*	<0.001
GOT, U/L	393.3±316.6	516.4±604.9	357.1±333.8	0.164
GPT, U/L	307.3±213.5	304.7±218.2	263.3±246.8	0.627
ISS, median (IQR)	18(9–29)	20(14–29)	25(18–38)*	0.016
1–15, n (%)	18(36.0)	50(27.8)	4(13.8)	0.105
16–24, n (%)	17(34.0)	65(36.1)	10(34.5)	0.995
≥ 25, n (%)	15(30.0)	65(36.1)	15(51.7)	0.149
LOS in hospital, days	13.5±11.3	19.0±13.1	37.5±29.6*	<0.001
Mortality, n (%)	0(0.0)	13(7.2)	7(24.1)*	<0.001

Note: *Indicates significance when compared to patients in the grade 1 group.

Abbreviations: CAD, coronary artery disease; CI, confidence interval; DM, diabetes mellitus; ESRD, end-stage renal disease; GCS, Glasgow Coma Scale; GOT, glutamic oxaloacetic transaminase (aspartate aminotransferase); GPT, glutamic pyruvic transaminase (alanine aminotransferase); HTN, hypertension; IQR, interquartile range; ISS, injury severity score; LOS, length of stay; OR, odds ratio.