Assessment of AST to platelet ratio index (APRI) and albumin-bilirubin score (ALBI) in patients with colorectal cancer: A stage-wise analysis

Background: Colorectal cancer (CRC) is the third most common malignancy globally and a leading cause of cancer-related death. Liver dysfunction and metastasis remain major contributors to poor outcomes. Noninvasive biomarkers such as the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) and the Albumin-Bilirubin (ALBI) score have shown potential in assessing liver function and predicting prognosis, but their stage-wise relevance in CRC is not well established. Methods: This retrospective observational study included 212 CRC patients aged ≥ 40 years admitted to Rasoul-e-Akram and Sina hospitals between 2015 and 2025. Patients were categorized into primary (stages 1 and 2) and advanced (stages 3 and 4) groups. APRI and ALBI scores were calculated from blood parameters and compared across stages using one-way ANOVA, chi-square, and Fisher’s exact tests. Odds ratios (OR) with 95% confidence intervals (CI) were computed, with p -value < 0.05 considered statistically significant. Results: Of the included patients, 57% had primary-stage CRC and 43% advanced-stage CRC. Both APRI and ALBI scores increased significantly with advancing cancer stage. Compared with primary stages, APRI showed an OR of 3.725 (95% CI: 1.723–7.783) and ALBI an OR of 1.926 (95% CI: 1.006–3.591) for advanced disease. Stage-wise analysis revealed that APRI ( p -value = 0.0128) and ALBI ( p -value = 0.03) were significantly higher in stage 4 compared to stage 3, with similar differences observed against earlier stages. Conclusion: APRI and ALBI scores increase with CRC progression, with the most pronounced elevations in stage 4. These indices offer simple, noninvasive, and cost-effective tools for assessing disease severity and guiding clinical decision-making. Prospective multicenter studies are needed to validate their prognostic utility and to establish standardized cut-off values.