Platelet–Albumin–Bilirubin Index for Predicting Hospitalization and Mortality in Pulmonary Hypertension

Abstract

BACKGROUND: Pulmonary hypertension (PH), a progressive multisystemic disorder characterized by right ventricular failure and hepatic congestion, significantly alters platelet dynamics and liver function. This study evaluated the ability of the platelet-albumin-bilirubin index (PALBI), a marker of the hepatic-cardiac axis, to discriminate between PH patients and healthy individuals and to predict 360-day all-cause mortality and heart failure-related hospitalizations (HFH). METHODS AND RESULTS: This retrospective study included 3,432 individuals (1,520 PH patients, identified based on high-risk echocardiographic parameters to reflect real-world clinical practice). PH patients had higher PALBI scores than healthy controls (-2.08 vs. -2.50; P=0.001). For disease discrimination, PALBI had an area under the curve (AUC) of 0.748 (cut-off -2.27; sensitivity 77%, specificity 80%), outperforming the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein. In the PH cohort (21.5% mortality; 36.4% HFH), PALBI was an independent predictor of 360-day mortality and HFH (odds ratios 1.24 [P=0.003] and 1.18 [P=0.006], respectively). PALBI (cut-off -1.98) outperformed estimated glomerular filtration rate, age, and NLR in predicting mortality; when combined with N-terminal pro B-type natriuretic peptide, mortality prediction accuracy rose by 15.6%. Kaplan-Meier analysis confirmed a significant stepwise decline in survival across PALBI tertiles (P<0.001). In Group I PH, the AUC for the combination of PALBI+REVEAL risk score was 0.064 higher than that for the REVEAL risk score alone (P<0.05). CONCLUSIONS: PALBI is a robust, cost-effective prognostic tool for PH. It independently predicts short-term mortality and HFH, offering enhanced risk stratification for high-risk patients in clinical settings.

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BibTeX RIS

BibTeX

@article{gelen2026plateletalbuminbilirubin,
  title = {{Platelet–Albumin–Bilirubin Index for Predicting Hospitalization and Mortality in Pulmonary Hypertension}},
  author = {Mehmet A. Gelen and Görkem Yıldız and Hasan A. Bolayır and Mehdi Karasu and Yusuf Akın and İlker Özer},
  journal = {Circulation Journal},
  year = {2026},
  month = oct,
  doi = {10.1253/circj.cj-26-0436},
  url = {https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0436/_article},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Platelet–Albumin–Bilirubin Index for Predicting Hospitalization and Mortality in Pulmonary Hypertension
AU  - Mehmet A. Gelen
AU  - Görkem Yıldız
AU  - Hasan A. Bolayır
AU  - Mehdi Karasu
AU  - Yusuf Akın
AU  - İlker Özer
PY  - 2026
DA  - 2026/10/23
JO  - Circulation Journal
DO  - 10.1253/circj.cj-26-0436
UR  - https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0436/_article
AB  - BACKGROUND: Pulmonary hypertension (PH), a progressive multisystemic disorder characterized by right ventricular failure and hepatic congestion, significantly alters platelet dynamics and liver function. This study evaluated the ability of the platelet-albumin-bilirubin index (PALBI), a marker of the hepatic-cardiac axis, to discriminate between PH patients and healthy individuals and to predict 360-day all-cause mortality and heart failure-related hospitalizations (HFH). METHODS AND RESULTS: This retrospective study included 3,432 individuals (1,520 PH patients, identified based on high-risk echocardiographic parameters to reflect real-world clinical practice). PH patients had higher PALBI scores than healthy controls (-2.08 vs. -2.50; P=0.001). For disease discrimination, PALBI had an area under the curve (AUC) of 0.748 (cut-off -2.27; sensitivity 77%, specificity 80%), outperforming the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein. In the PH cohort (21.5% mortality; 36.4% HFH), PALBI was an independent predictor of 360-day mortality and HFH (odds ratios 1.24 [P=0.003] and 1.18 [P=0.006], respectively). PALBI (cut-off -1.98) outperformed estimated glomerular filtration rate, age, and NLR in predicting mortality; when combined with N-terminal pro B-type natriuretic peptide, mortality prediction accuracy rose by 15.6%. Kaplan-Meier analysis confirmed a significant stepwise decline in survival across PALBI tertiles (P<0.001). In Group I PH, the AUC for the combination of PALBI+REVEAL risk score was 0.064 higher than that for the REVEAL risk score alone (P<0.05). CONCLUSIONS: PALBI is a robust, cost-effective prognostic tool for PH. It independently predicts short-term mortality and HFH, offering enhanced risk stratification for high-risk patients in clinical settings.
SN  - 1347-4820
SN  - 1346-9843
ER  -

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