Value of APRI, FIB-4 and ALBI for Child-Pugh Stratification in Patients with Liver Cirrhosis: A Multivariable Analysis and Diagnostic Performance Study

Background/Objectives: The Child-Pugh system is widely used to grade cirrhosis severity but includes clinical components that may be variably documented. This study evaluated the association and diagnostic performance of the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) index, and albumin-bilirubin (ALBI) score for discriminating Child-Pugh classes in cirrhosis. Methods: We conducted a retrospective cross-sectional study using medical records from 302 adults with cirrhosis treated at Thai Binh General Hospital, Vietnam, from January to June 2025. Child-Pugh class was reconstructed from bilirubin, albumin, PT%, ascites, and hepatic encephalopathy. APRI, FIB-4, and ALBI were calculated from routine laboratory data. Group comparisons, correlation analysis, multivariable regression, receiver operating characteristic analysis with bootstrap 95% confidence intervals, optimal cut-offs, and reclassification metrics were assessed. Results: Among 302 patients, 48 (15.9%) were Child-Pugh A, 120 (39.7%) Child-Pugh B, and 134 (44.4%) Child-Pugh C. ALBI values differed consistently across Child-Pugh classes (-2.23 ± 0.37, -1.65 ± 0.45, and -0.80 ± 0.46; p < 0.001), whereas APRI and FIB-4 showed less distinct separation between classes. ALBI showed a strong correlation with the Child-Pugh score (r = 0.853, p < 0.001) and remained associated with Child-Pugh severity in multivariable linear and logistic regression models. Among the three indices, ALBI showed the highest discrimination for Child-Pugh B/C versus A in this cohort (AUC, 0.919; 95% CI, 0.884-0.950), with an estimated optimal cut-off of -1.753. Conclusions: In this retrospective cohort, ALBI showed closer agreement with Child-Pugh severity and higher discrimination for Child-Pugh B/C versus A than APRI and FIB-4. ALBI may be considered as a simple laboratory-based adjunct to support Child-Pugh stratification in routine cirrhosis assessment, but further prospective validation is required before broader clinical application.