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Clinical calculator summary

Original 2015 ALBI grade

An objective two-variable grade of liver function based on total bilirubin and albumin.

Evidence-based context for fast calculator use

Purpose:
Provide prognostic liver-function stratification in hepatocellular carcinoma.
Population:
Patients with hepatocellular carcinoma in the original international development and validation cohorts.
Factors:
Total bilirubin in micromol/L, Albumin in g/L
Reference:
Johnson et al. J Clin Oncol. 2015;33:550-558. PMID 25512453.
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ALBI Score

µmol/L
g/L

Clinical Context & Background

This calculator implements the original Albumin-Bilirubin (ALBI) grade described by Johnson and colleagues in 2015. It uses total bilirubin in micromol/L and albumin in g/L, classifies the unrounded raw score, and normally displays the score to two decimals. When two-decimal rounding would place the headline exactly on the opposite cutoff side, the display uses >-2.60 or >-1.39 so it remains visibly consistent with the raw-score grade.
ALBI is an objective prognostic liver-function grade developed in patients with hepatocellular carcinoma. It is not a treatment-selection rule, transplant-priority score, or acute liver-failure tool. This page does not implement modified ALBI, EZ-ALBI, PALBI, or ALBI-T.
Primary Source EvidenceJohnson PJ, Berhane S, Kagebayashi C, 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):550-558. PMID 25512453. doi:10.1200/JCO.2014.57.9151.
Formula Logic
ALBI = 0.66 x log10(total bilirubin [micromol/L]) - 0.085 x albumin [g/L]

Reference Data

ALBI GradeRaw score cutoffOriginal prognostic interpretation
Grade 1<= -2.60Better preserved liver function
Grade 2> -2.60 to <= -1.39Intermediate liver function
Grade 3> -1.39Poorer liver function

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use for objective prognostic description of liver function in the HCC context represented by the original ALBI evidence.
  • Enter contemporaneous total bilirubin in micromol/L and albumin in g/L without unit inference.

How To Interpret

  • Grade 1 is raw ALBI <= -2.60; Grade 2 is > -2.60 to <= -1.39; Grade 3 is > -1.39.
  • The unrounded raw score determines the grade; the displayed score normally uses two decimals and uses a boundary-safe greater-than label only when ordinary rounding would contradict the grade.

What To Do Next

  • Interpret the grade alongside the full clinical assessment, tumor stage, treatment context, and current guidance.
  • Confirm laboratory units and timing before documenting or comparing results.

Limitations

  • Not a treatment-selection rule, transplant-priority score, or acute liver-failure tool.
  • Does not implement mALBI, EZ-ALBI, PALBI, or ALBI-T.

Validated Population

International hepatocellular carcinoma cohorts in the original 2015 publication.

Reference calculation

Total bilirubin 20 micromol/L and albumin 35 g/L gives raw ALBI -2.116320202862..., displayed -2.12, Grade 2.

Liver cancer calculator hubReview HCC liver-function, staging, and transplant-context tools.ALBI score clinical guideReview the original equation, units, evidence, and interpretation.Child-Turcotte-PughCompare the separate clinical liver-disease severity classification.BCLC HCC stagingUse a separate tumor-stage and attributable-performance-status framework.HKLC HCC stagingUse the original nine-category 2014 staging framework.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed ALBI cases passed through visible production controls across Grades 1, 2, and 3, including the former first-submission reference profile.
    • The unsupported generic risk gauge was absent, and no unexpected N/A, literal undefined value, stale control, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/albi-liver-function-grade-2026-08-03.json.

  2. : Local browser remediation verified; production retest pending

    • Preserved the original 2015 ALBI equation and full-precision grade classification while adding a boundary-safe headline display when two-decimal rounding would contradict the raw cutoff side.
    • Ten source-backed cases passed through visible local browser controls across 11 submissions, including the first complete submission, all three grades, both exact cutoffs and just-above transitions, positive-domain input, validation, and reset/repeat behavior.
    • The shared gauge correction keeps unsupported generic Low/Intermediate/High labels absent. Original production findings remain open until deployment and public revalidation.

    Case-level local remediation evidence is retained in validation/browser-production/albi-liver-function-grade.local-remediation.json.

  3. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 9/10 case records passed their expected-versus-observed assertions across 12 visible submissions.
    • Overall browser status: failed-calculation-ui-and-console. high: The first complete 20 micromol/L bilirubin and 35 g/L albumin reference submission produced no result and two required-field messages. An immediate identical supplemental production submission returned the correct -2.12 Grade 2 result. | medium: Every valid Grade 1, 2, or 3 result added a generic Low Risk / Intermediate / High Risk gauge although ALBI defines liver-function grades, not those generic risk classifications. | high: Raw scores immediately above -2.60 and -1.39 display as -2.60 Grade 2 and -1.39 Grade 3, respectively, while the visible reference table assigns displayed equality values to Grade 1 and Grade 2. The detailed documentation explains raw-score classification, but the headline score and grade remain visibly contradictory. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/albi-liver-function-grade.json.

  4. : Browser input adapter corrected and reverified

    • Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
    • No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.

  5. : Full validation test

    • 128/128 independent equation, boundary, malformed-input, UI, trace, immutability, and liver-panel parity checks passed with zero numerical difference.
    • Original 2015 ALBI only; ALBI-T and the overall liver panel remain unverified.

  6. : Input-contract correction

    • Removed Number coercion and enforced exactly two positive finite numeric engine inputs in canonical units, with no extras, defaults, inferred units, or maxima.
    • Classified the unrounded raw score, retained two-decimal display, added a source-exact trace and HCC scope warning, and isolated the liver-panel projection to bilirubin and albumin only.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

Which ALBI version is implemented?

The original 2015 ALBI grade only. Modified ALBI, EZ-ALBI, PALBI, and ALBI-T are not included in this calculation.

Which units are required?

Total bilirubin must be entered in micromol/L and albumin in g/L. The calculator does not infer or convert other units.

Does the rounded score determine the grade?

No. The unrounded raw score is classified first. The headline normally uses two decimals, but shows >-2.60 or >-1.39 when ordinary rounding would otherwise contradict the raw-score grade.

What are the original ALBI grade cutoffs?

Grade 1 is a raw score at or below -2.60, Grade 2 is above -2.60 through -1.39, and Grade 3 is above -1.39.

How is ALBI different from Child-Pugh?

ALBI uses only albumin and bilirubin as continuous objective variables. Child-Pugh uses additional clinical and laboratory categories, so the two systems should not be treated as interchangeable.

Does an ALBI grade select HCC treatment?

No. ALBI describes prognostic liver-function context and must be integrated with tumor stage, clinical status, treatment goals, and current guidance.

Evidence-based oncology decision support. Verify with clinical guidelines.