Impact of the albumin-bilirubin score on short- and long-term mortality in native and prosthetic valve endocarditis ALBI score and mortality in native and prosthetic valve endocarditis.

BACKGROUND

Infective endocarditis (IE), involving both native and prosthetic valves, remains a severe multisystem disease associated with high early and long-term mortality despite advances in antimicrobial therapy and cardiac surgery. Early risk stratification is important for clinical decision-making; however, existing prognostic models are often complex and may include subjective variables. The albumin-bilirubin (ALBI) score, derived from routinely available laboratory parameters, reflects hepatic dysfunction and systemic inflammatory burden and may represent a prognostic tool in IE.

METHODS

This retrospective cohort study included 130 patients with native or prosthetic valve IE evaluated at a tertiary cardiovascular referral centre. The ALBI score was calculated at admission. The primary endpoint was 30-day all-cause mortality, while long-term mortality was assessed as a secondary outcome. Associations between ALBI score and outcomes were evaluated using multivariable logistic regression, generalised additive models, and Cox proportional hazards regression.

RESULTS

Higher ALBI scores were associated with increased inflammatory burden and impaired renal function. The admission ALBI score independently predicted 30-day mortality (odds ratio per 1-SD increase: 2.22, p = 0.014). A non-linear relationship between ALBI score and early mortality was observed (p = 0.0002). During follow-up, ALBI remained independently associated with mortality (hazard ratio per 1-SD increase: 1.92, p < 0.001). Incremental analyses demonstrated improved discrimination and risk reclassification after the addition of ALBI to a baseline clinical model.

CONCLUSION

The admission ALBI score may serve as a simple and objective marker for risk stratification in infective endocarditis and may provide incremental prognostic information beyond established clinical risk domains. These findings require external validation in larger multicentre cohorts.