PALBI blood score may identify high-risk pulmonary hypertension patients
Higher PALBI scores linked to mortality and heart failure admissions
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A score based on three routine blood tests may help identify people with pulmonary hypertension (PH) who are at higher risk of dying or being hospitalized for heart failure within about a year, a study in Turkey suggests.
The platelet–albumin–bilirubin index, or PALBI, helped distinguish people with PH from those without it. Higher scores were also linked to greater odds of death or hospitalization for worsening right-sided heart failure, even after researchers accounted for other clinical factors. The findings suggest PALBI could help identify patients who may need closer monitoring or more intensive treatment.
Blood-based score may help identify high-risk PH patients
“PALBI is a robust, cost-effective prognostic tool for PH,” the researchers wrote. “It independently predicts short-term mortality and [heart failure-related hospitalizations], offering enhanced risk stratification for high-risk patients in clinical settings.”
The study, “Platelet–Albumin–Bilirubin Index for Predicting Hospitalization and Mortality in Pulmonary Hypertension,” was published in the Circulation Journal.
PH causes high blood pressure in the blood vessels of the lungs. This forces the right side of the heart to work harder to pump blood through the lungs. Over time, this strain can lead to right-sided heart failure. Despite advances in treatment, identifying people at greater risk of serious complications remains a challenge.
Some clues may come from the liver. When the right side of the heart cannot pump blood effectively, blood can back up into the liver and affect how well it works. These changes may show up in routine blood tests.
PALBI uses three blood measurements: platelet counts, albumin levels, and bilirubin levels. Platelets are cell fragments that help blood clot. Albumin is a protein made by the liver, while bilirubin is a substance produced when red blood cells break down. Originally developed to assess liver function in people with liver cancer, the score has also shown promise in predicting the risk of death among people with heart failure and critically ill patients.
“However, the role of PALBI in PH remains systematically unexplored,” the researchers wrote.
Researchers compare blood scores in more than 3,400 people
To investigate, the researchers reviewed medical records from 1,520 adults identified as having PH at a hospital in Turkey between January 2020 and January 2025. PH was identified using heart ultrasound findings, with additional testing to confirm the diagnosis in some patients. Another 1,912 people of similar age and sex, evaluated during the same period but without signs of PH on heart ultrasound, served as a comparison group.
Participants with PH had a median age of 70, and 45% were women. Most had PH caused by left-sided heart disease (48.4%) or lung disease (39.8%). The others had pulmonary arterial hypertension (PAH; 6.9%) or chronic thromboembolic PH (CTEPH; 4.9%).
The team calculated PALBI using blood samples collected during each patient’s first evaluation, before targeted PH treatment or major treatment changes. They then tracked patients’ outcomes over 360 days, or about one year.
PALBI scores were significantly higher in people with PH than in the comparison group. However, scores did not differ significantly among the different types of PH. At the chosen cutoff, the score correctly identified about 77% of patients with PH and 80% of those without it.
PALBI performed similarly to NT-proBNP, a blood marker of heart strain used to assess patients’ risks. Both were better at distinguishing people with PH from those without it than the neutrophil-to-lymphocyte ratio and C-reactive protein, two markers of inflammation previously linked to disease severity and poorer survival in PH.
The score also provided information about patients’ risk of death or hospitalization. During follow-up, 327 people with PH (21.5%) died, and 553 (36.4%) were hospitalized for worsening right-sided heart failure. Progressive right-sided heart failure accounted for just over half (54.1%) of the deaths.
Higher PALBI scores linked to greater odds of death and hospitalization
Patients who died had significantly higher PALBI scores than those who survived. Even after accounting for age, kidney function, markers of inflammation, and NT-proBNP, each 0.1-point increase in PALBI was linked to 24% higher odds of death and 18% higher odds of hospitalization for worsening right-sided heart failure. Similar associations were seen when researchers looked only at patients with PAH.
PALBI and NT-proBNP were better at predicting death over about one year than age, kidney function, or the neutrophil-to-lymphocyte ratio. At the chosen cutoff, PALBI correctly identified about 71% of patients who died and 78% of those who survived.
PALBI also improved the performance of an established risk assessment tool. Among patients with PAH, adding PALBI to REVEAL Lite 2.0 — a tool used to estimate the risk of death in people with PAH — significantly improved how well the combined scores distinguished patients who later died from those who survived during the one-year follow-up.
The researchers said PALBI “offers a practical and scalable tool for risk stratification.” They added that, because PALBI uses routine blood measurements, it is “ideal for serial outpatient monitoring, providing clinicians with an accessible means to assess the systemic burden of PH and optimize the timing of interventions across diverse clinical settings.”
“Prospective multicenter studies are needed to validate its integration into standard PH management and diagnostic algorithms,” the researchers concluded.
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