Albumin-Bilirubin Score and De Ritis Ratio in Assessing Disease Severity in Intrahepatic Cholestasis of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes. Simple prognostic biomarkers are needed for risk stratification. The Albumin-Bilirubin (ALBI) score and Aspartate Aminotransferase to Alanine Aminotransferase ratio (De Ritis) are established liver function indices, but their comparative utility for predicting adverse perinatal outcomes in ICP remains inadequately explored.This study aimed to evaluate and compare the prognostic performance of the ALBI score and the De Ritis ratio for predicting ICP and adverse perinatal outcomes.Methods: A retrospective study was conducted utilizing a publicly available dataset comprising 100 pregnant women with a diagnosis of ICP. The ALBI score and De Ritis ratio were calculated from serum biomarkers. Univariate and multivariable logistic regression were used to assess associations, presented as odds ratios (OR) with 95% confidence intervals (CI). Predictive performance was evaluated using Receiver Operating Characteristic (ROC) curve analysis, reporting the area under the curve (AUC), sensitivity, and specificity.Results: In univariate analysis, the ALBI score was a significant predictor of adverse outcomes (OR=20.54, p<0.001), while the De Ritis ratio was not (OR=0.78, p=0.42). The ALBI score demonstrated significantly superior discriminatory power (AUC=0.712). In multivariable models adjusting for gestational age, maternal age, ALP, and GGT, the ALBI score remained a strong, independent predictor (fully adjusted OR=21.65, p=0.006), whereas the De Ritis ratio was consistently non-significant. A model combining both scores showed good predictive performance (AUC=0.714), which was significantly enhanced to an excellent level (AUC=0.845) after full adjustment for clinical covariates.Conclusion: The ALBI score is a significant and independent predictor of ICP and adverse perinatal outcomes in the pregnancy, demonstrating good prognostic utility. In contrast, the De Ritis ratio showed no meaningful predictive value. The ALBI score could serve as a useful clinical tool for risk assessment in this patient population.