The Albumin-Bilirubin Grade and Cognitive Function in Liver Cirrhosis; Animal Naming Test and Non-Invasive Liver Biomarkers

Background: Cognitive impairment is a frequent complication of cirrhosis, and its relationship with hepatic functional reserve remains incompletely understood. The Albumin-Bilirubin (ALBI) score provides an objective measure of liver dysfunction, but its association with cognitive outcomes in cirrhosis requires clarification. Methods: This retrospective secondary analysis utilized a publicly available cohort of 268 patients with cirrhosis. Demographic, clinical, and laboratory parameters were extracted, including ALBI, Model for End-Stage Liver Disease (MELD), and Child-Pugh classification. Cognitive function was measured with the Animal Naming Test (ANT), with scores <20 indicating impairment. Associations between ALBI and clinical outcomes were evaluated. Results: The mean age was 59.1±10.6 years, 58.6% were male, and 47.4% exhibited cognitive impairment. ALBI correlated significantly with MELD (ρ=0.67, p<0.0001), Child-Pugh class (ρ=0.60, p<0.0001), history of ascites (ρ=0.40, p<0.0001), and minimal hepatic encephalopathy (ρ=0.16, p=0.007), but not with ANT performance. Linear regression showed no significant association between ALBI and ANT scores (β=−0.48, p=0.374). Logistic regression confirmed minimal hepatic encephalopathy (OR=4.46, 95% CI:2.39–8.56, p<0.0001) and lower education (OR=0.82, 95% CI:0.69–0.97, p=0.022) as independent predictors of cognitive impairment, whereas ALBI was not significant in any model. Model performance improved with additional covariates. Conclusion: While the ALBI score correlated with established indices of liver disease severity, it was not independently associated with cognitive impairment. Instead, minimal hepatic encephalopathy and lower education emerged as the strongest predictors. These findings suggest that cognitive decline in cirrhosis may be more strongly driven by neurocognitive and socioeconomic factors than by hepatic synthetic reserve alone.