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ALBI grade: a newer way to measure liver function in liver cancer | CION Cancer Clinics
The ALBI grade is a measure of liver function built from two blood tests, albumin and bilirubin. It sorts the liver into grade 1, 2 or 3, with grade 1 working best, and helps your team judge how well the liver will cope with treatment. It grades the liver, not the cancer. This page explains what goes into it, how it differs from Child-Pugh, and what it cannot tell you. At CION Cancer Clinics, our team goes through your scan, blood test and biopsy reports with you and plans the next step.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What does an ALBI grade mean on a liver cancer report?
- What goes into the ALBI grade, and what does not?
- How is ALBI different from Child-Pugh?
- How does the team use an ALBI grade to plan treatment?
- What do families often misunderstand about ALBI?
- What this page cannot tell you
- Common questions about the ALBI grade
The short answer
What does an ALBI grade mean on a liver cancer report?
ALBI stands for albumin and bilirubin, the two blood tests it is built from. It sorts liver function into grade 1, grade 2 or grade 3, where grade 1 means the liver is working best. Doctors use it to judge how well the liver will cope with treatment for a cancer that started in the liver.
Why a newer score was needed
The older measure, Child-Pugh, includes two things a doctor judges by eye: how much fluid is in the abdomen and how confused a person seems. Two doctors can score the same patient differently. ALBI uses only laboratory numbers, so it gives the same answer whoever works it out.
It was designed with liver cancer in mind
Child-Pugh was built for cirrhosis in general. ALBI was developed by studying people with hepatocellular carcinoma (HCC), the most common cancer that starts in the liver. It is especially good at showing differences among people whose Child-Pugh class looks the same.
ALBI measures the liver, not the tumour. It is always read beside the scan and the BCLC stage.Two blood tests
What goes into the ALBI grade, and what does not?
Both numbers are on an ordinary liver function test report. A formula combines them into a score, and the score falls into a grade.
Albumin
A protein the liver makes, which helps keep fluid inside the blood vessels. A low albumin suggests the liver is making less than it should, though poor eating and kidney problems can lower it too.
Bilirubin
A yellow pigment the liver clears into the bile. When the liver struggles, bilirubin rises in the blood. A blocked bile duct can raise it as well, which your team will rule out.
What ALBI leaves out
It does not measure everything that matters in a liver.
- Fluid in the abdomen (ascites)
- Confusion caused by the liver (hepatic encephalopathy)
- How fast the blood clots (INR)
- Kidney function
The three grades
Grade 1 is the best-preserved liver function. Grade 2 is in the middle and covers many people. Grade 3 means the liver is under real strain. Some teams split grade 2 into a higher and lower half for finer decisions.
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How is ALBI different from Child-Pugh?
ALBI grade
Child-Pugh class
Two blood tests only
Three blood tests plus two bedside judgements
Same answer whoever calculates it
Can vary between doctors on fluid and confusion
Developed in people with liver cancer
Developed for cirrhosis in general
Separates people within Child-Pugh A
Puts most early patients in one group, class A
Used more in research and newer guidance
Still the main score in most treatment rules
In a treatment plan
How does the team use an ALBI grade to plan treatment?
It is worked out from recent bloods
The grade comes from your latest albumin and bilirubin. It is repeated before each major step, because liver function can shift after a procedure, an infection or a bleed.
The tumour board reads it with everything else
At CION, the tumour board looks at the scan, the stage, Child-Pugh class, ALBI grade and how active you are. No single number makes the decision.
It helps judge how much a liver can take
Before an operation, ablation or TACE, a better grade gives more confidence that the remaining liver will cope. A worse grade may push the team towards a gentler option.
It is watched during tablets or immunotherapy
During targeted therapy or immunotherapy, a falling grade can be an early warning that the liver is struggling. It may lead to a pause or a change of plan rather than pressing on.
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Commonly believed
What do families often misunderstand about ALBI?
"Grade 3 means the cancer is at its last stage."
ALBI grades the liver, not the cancer. A person can have a small tumour with a weak liver, or a large tumour with a strong one. The stage comes from the scan and from the liver together.
"The grade tells us how much time is left."
Research uses ALBI to compare large groups of people. It cannot predict what will happen to one person. Ask what the grade means for treatment choices, which is the question it can help answer.
"He should stop eating protein to protect his liver."
Cutting protein can lower albumin and weaken the muscles needed for treatment. Most people with liver disease need enough protein, not less. Ask your team or a dietitian what to eat.
"A liver tonic will improve the numbers."
Herbal and detox products can harm a liver that is already damaged. Tell your oncologist about anything you take, without worrying about being judged, so the team can read your results correctly.
Being straight with you
What this page cannot tell you
It cannot tell you what your own grade means for you. The same grade can lead to different advice depending on the size and number of tumours, the stage, how well you are and what has changed recently. Your oncologist reads it as one piece of a larger picture, alongside the other blood tests.
The evidence is still building
ALBI is well studied, but it has not replaced Child-Pugh in most treatment rules or drug approvals. Many reports in India will show Child-Pugh and not ALBI. That is normal, and it does not mean anything was missed.
Who this does not apply to
If the cancer spread to your liver from another organ, such as the bowel or breast, ALBI is rarely used, and your plan rests on where the cancer began. It is also less useful when bilirubin is raised by a blocked bile duct rather than by liver damage.
Bring your latest liver function report to your consultation. Ask which score your team relies on, and why.Questions we are asked
Common questions about the ALBI grade
Is ALBI grade 2 good or bad?
It is in the middle. Grade 2 means the liver is under some strain but still working. Many people with liver cancer sit in this grade and go on to have active treatment. What it means for you depends on the tumour, the stage and your other results.
Can my ALBI grade improve?
Sometimes. If the reason for the strain is treated, such as an infection, a blocked bile duct, poor nutrition or active hepatitis, albumin and bilirubin can improve, and the grade with them. Your hepatologist and oncologist can tell you what is realistic in your case.
Why does my report show Child-Pugh but not ALBI?
Child-Pugh is still the score most treatment rules are written around, so it is the one most reports carry. Your team can work out ALBI from the same blood tests in moments if it helps a decision. Its absence does not mean your care is incomplete.
Is ALBI used for cancer that has spread to the liver?
Rarely. ALBI was developed for cancer that started in the liver, usually on a background of liver disease. When cancer spreads to a healthy liver from another organ, the plan depends mainly on the original cancer. Ask your oncologist which page of advice fits you.
Does a better ALBI grade mean I can have surgery?
Not on its own. Surgery depends on the size, number and position of the tumours, the pressure in the liver's blood vessels, and how much healthy liver would be left. A good grade is helpful, but CION's surgical oncologists assess the whole picture before recommending an operation.
Is ALBI the same as the MELD score?
No. MELD uses bilirubin, INR, creatinine and often sodium, and it is mainly used to rank people for a liver transplant. ALBI uses only albumin and bilirubin, and it is used more to judge how well a liver will cope with cancer treatment.
Can I calculate my ALBI grade myself?
The formula is published and online calculators exist. The difficulty is not the arithmetic but the reading. A grade on its own, without the scan and the rest of your results, is more likely to worry you than to help. Take it to your doctor instead.
What should I ask the doctor about liver function?
Ask which liver score your team is using, what your latest result is and whether it is changing. Then ask which treatments it opens up or rules out. Write the answers down, or call the CION helpline if you need help preparing for the consultation.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- MedlinePlus — Liver Function Tests
- MDCalc — Child-Pugh Score for Cirrhosis Mortality Calculator
- American Cancer Society — Liver Cancer Stages
- National Cancer Institute — Liver Cancer Stages
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Child-Pugh A, B and C explainedThe older score most treatment rules still useWhy Child-Pugh decides what treatment you can haveHow liver function narrows the optionsThe MELD score and what it is used forThe liver score used for transplantBlood tests in liver cancer and what each one tells youEvery number on the report, in plain words
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Not sure what the liver scores on your report mean?
Bring your latest blood reports and scan, and an oncologist will explain what they change for your treatment. One helpline serves every CION centre.