Association of albumin–bilirubin score with clinical severity and outcome in patients with decompensated heart failure: a retrospective cohort study

The Albumin–Bilirubin (ALBI) score is a simple marker of hepatic function that may reflect systemic congestion in heart failure. Therefore, the present retrospective cohort study aimed to investigate the association between ALBI score and clinical severity, echocardiographic findings, and hospitalization outcomes in patients admitted with decompensated heart failure. Exploratory analyses were additionally performed to examine potential associations between ALBI score and in-hospital mortality. This retrospective cohort study included adults (≥ 18 years) admitted with decompensated heart failure with reduced or mildly reduced ejection fraction at Rajaiee Hospital, Alborz University of Medical Sciences, Karaj, Iran, from March 2022 to March 2025. 152 patients met the inclusion criteria after excluding those with preserved ejection fraction, liver or renal disease, malignancy, or incomplete data. Clinical, laboratory, and echocardiographic data were extracted. The ALBI score was calculated using serum albumin and bilirubin. Statistical analysis included correlation, t-tests, multivariable linear regression, and ROC curve analysis. A total of 152 patients (47.4% female) with a mean age of 66.70 ± 12.73 years were included. Mean left ventricular ejection fraction (LVEF) was 27.34 ± 13.15%. Because only three in-hospital deaths occurred, mortality-related analyses were considered exploratory. In-hospital mortality occurred in 3 patients (2%), whereas other patients were discharged, with no significant difference in ALBI score between survivors and non-survivors ( p = 0.709). Mean hospitalization duration was 7.85 ± 5.59 days. The mean ALBI score was − 2.79 ± 0.45 in females and − 2.64 ± 0.46 in males ( p = 0.040). Patients with LVEF ≤ 30% had significantly higher ALBI scores than those with LVEF > 30% (− 2.65 ± 0.44 vs. − 2.83 ± 0.46, p = 0.022). However, no significant correlation was found between age and ALBI score ( r = − 0.055, p = 0.499), but multivariable analysis showed that presenting comorbidity of hypertension (β = −0.187, p = 0.009) was independently associated with ALBI score. Analysis showed a small, significant association of AST (β = −0.006, p = 0.035) and ALP (β = 0.001, p = 0.030) with ALBI score as well. Through the analysis, ALBI showed weak predictive ability for prolonged hospitalization (AUC = 0.58, 95% CI: 0.49–0.68, p = 0.078). The ALBI score was associated with sex and heart failure severity, whereas analyses of in-hospital mortality remained exploratory because of the low number of events. Larger studies are needed to confirm its clinical utility.