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Background <p>Intermediate–high-risk pulmonary embolism (PE) carries substantial early and long-term mortality, yet validated biomarkers for risk stratification remain limited. Liver function–based indices, such as the albumin–bilirubin (ALBI) and platelet–albumin–bilirubin (PALBI) scores, may capture systemic compromise related to venous congestion and impaired hepatic perfusion, but their prognostic role in PE has not been established.</p> Methods <p>We conducted a single-center, retrospective cohort study of 274 patients with intermediate–high-risk acute PE admitted between January 2023 and March 2024. Baseline demographic, clinical, echocardiographic, and laboratory parameters were collected, and ALBI and PALBI scores were calculated within 24&#xa0;h of admission. The primary endpoint was long-term all-cause mortality.</p> Results <p>During a median follow-up of 18&#xa0;months, 65 patients (23.7%) died. Non-survivors had significantly higher ALBI (–2.53 vs. –3.13, <i>p</i> &lt; 0.001) and PALBI (–2.75 vs. –3.04, <i>p</i> &lt; 0.001) scores. Both indices independently predicted mortality after multivariable adjustment. ALBI (HR 2.821, 95% CI 1.161–4.792, <i>p</i> &lt; 0.001) and PALBI (HR 1.837, 95% CI 1.093–3.086, <i>p</i> = 0.022) were strong prognostic markers. ROC analyses demonstrated discriminative accuracy for both indices, with an AUC of 0.764 for ALBI and 0.682 for PALBI. Survival analyses showed stepwise mortality increases across score tertiles (log-rank <i>p</i> &lt; 0.001).</p> Conclusions <p>This study is the first to demonstrate that ALBI and PALBI scores provide independent and incremental prognostic value for long-term mortality in patients with intermediate–to–high–risk PE. These indices represent simple, cost-effective tools that may enhance current risk stratification frameworks. External validation in larger cohorts is warranted.</p>

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Albumin–Bilirubin and Platelet–Albumin–Bilirubin scores as predictors of all-cause long-term mortality in intermediate–high-risk pulmonary embolism

  • 期刊论文

  • 发表日期：

    2025年12月5日

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  • Alperen Taş,
  • Veysel Ozan Tanık,
  • Çağatay Tunca,
  • Muhammet Salih Ateş,
  • Fatmanur Oğuz,
  • Ceren Kılıç,
  • Kürşat Akbuğa,
  • Süleyman Barutçu,
  • Bülent Özlek

摘要

Background

Intermediate–high-risk pulmonary embolism (PE) carries substantial early and long-term mortality, yet validated biomarkers for risk stratification remain limited. Liver function–based indices, such as the albumin–bilirubin (ALBI) and platelet–albumin–bilirubin (PALBI) scores, may capture systemic compromise related to venous congestion and impaired hepatic perfusion, but their prognostic role in PE has not been established.

Methods

We conducted a single-center, retrospective cohort study of 274 patients with intermediate–high-risk acute PE admitted between January 2023 and March 2024. Baseline demographic, clinical, echocardiographic, and laboratory parameters were collected, and ALBI and PALBI scores were calculated within 24 h of admission. The primary endpoint was long-term all-cause mortality.

Results

During a median follow-up of 18 months, 65 patients (23.7%) died. Non-survivors had significantly higher ALBI (–2.53 vs. –3.13, p < 0.001) and PALBI (–2.75 vs. –3.04, p < 0.001) scores. Both indices independently predicted mortality after multivariable adjustment. ALBI (HR 2.821, 95% CI 1.161–4.792, p < 0.001) and PALBI (HR 1.837, 95% CI 1.093–3.086, p = 0.022) were strong prognostic markers. ROC analyses demonstrated discriminative accuracy for both indices, with an AUC of 0.764 for ALBI and 0.682 for PALBI. Survival analyses showed stepwise mortality increases across score tertiles (log-rank p < 0.001).

Conclusions

This study is the first to demonstrate that ALBI and PALBI scores provide independent and incremental prognostic value for long-term mortality in patients with intermediate–to–high–risk PE. These indices represent simple, cost-effective tools that may enhance current risk stratification frameworks. External validation in larger cohorts is warranted.