Integrated routine laboratory indices for risk stratification in HBV-related cirrhosis: a real-world study

BACKGROUND: Chronic hepatitis B (CHB) is characterized by progressive structural and functional liver impairment involving hepatic dysfunction, fibrosis accumulation, and nutritional-immune imbalance. Although non-invasive indices derived from routine laboratory parameters-such as the albumin-bilirubin (ALBI) score, fibrosis-4 (FIB-4) index, and prognostic nutritional index (PNI)-are widely used, their integrated value for stage-based risk stratification in HBV-related liver disease remains unclear. AIMS: To develop and internally validate a clinically applicable, non-invasive risk stratification framework based on ALBI, FIB-4, and PNI, and to evaluate its performance across different clinical stages of HBV-related liver disease. METHODS: We conducted a single-center retrospective cross-sectional study including 842 hospitalized patients with HBV-related liver disease. Patients were categorized as chronic hepatitis B, compensated cirrhosis, or decompensated cirrhosis at admission. ALBI, FIB-4, and PNI were calculated from routine laboratory data. Ordinal logistic regression was used to identify factors associated with advanced disease stage. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, and calibration was evaluated. Factors associated with hepatic encephalopathy were explored in patients with decompensated cirrhosis. RESULTS: ALBI and FIB-4 increased with higher disease stage, whereas PNI declined significantly (all P < 0.001). Multivariable analysis identified age, ALBI, and FIB-4 as independent factors associated with advanced stage, while PNI and platelet count were inversely associated. The combined framework was associated with improved discrimination for disease stages compared with individual indices, with further enhancement after incorporation of prothrombin time (PT). Higher ALBI values were independently associated with hepatic encephalopathy among patients with decompensated cirrhosis. CONCLUSIONS: An integrated framework combining ALBI, FIB-4, PNI, and PT may provide a simple, interpretable, and cost-accessible tool for stage-based risk stratification in HBV-related liver disease within hospitalized populations.