Intern Emerg Med. 2026 Jun 5. doi: 10.1007/s11739-026-04419-6. Online ahead of print.
ABSTRACT
Gallstones are a common digestive disorder whose development is influenced by abnormal liver function, metabolic disorders, and inflammatory states. The albumin-bilirubin (ALBI) score is a comprehensive indicator for assessing liver function and has been widely applied in liver cancer and chronic liver diseases; however, its association with gallstones remains unclear. This study analyzed NHANES data from 2017 to 2020, including 6332 adult participants. Survey-weighted multivariable logistic regression was performed to assess the association between ALBI and gallstone prevalence. Furthermore, the dose-response relationship was examined using restricted cubic spline (RCS) modeling. Subgroup analyses were conducted to assess the robustness of this association across different demographic and clinical strata. In addition, an exploratory mediation analysis was performed to examine whether body mass index (BMI) statistically accounted for part of the observed association between ALBI and gallstone prevalence. Multivariable logistic regression indicated that higher ALBI was associated with higher odds of gallstone prevalence (OR = 2.670, 95% CI: 1.778 – 4.008, P = 0.001). RCS analysis indicated that the relationship between ALBI and gallstones is approximately linear (P-overall < 0.0001, P-nonlinearity = 0.7779). The results of the subgroup analyses were consistent and robust. Exploratory mediation analysis suggested that BMI statistically accounted for 23.95% of the observed association between ALBI and gallstone prevalence in the mediation model. Higher ALBI levels were associated with a higher prevalence of gallstones, showing an approximately linear dose-response pattern. BMI statistically accounted for part of this association in exploratory mediation models, but this finding should not be interpreted as evidence of causal mediation given the cross-sectional design. Because gallstone status was self-reported, these findings should be interpreted with caution. Prospective studies are warranted to clarify temporal relationships, validate these associations, and determine whether ALBI provides clinically meaningful information beyond established gallstone risk factors.
PMID:42247086 | DOI:10.1007/s11739-026-04419-6
