Background/Aim: This study investigated the relationship between albumin-bilirubin (ALBI) grade and advanced liver fibrosis in patients with a history of gallstone disease and cholecystectomy, focusing on those diagnosed with metabolic dysfunctionassociated steatohepatitis (MASH) using the acMASH algorithm. Methods: Data from 566 subjects in the National Health and Nutrition Examination Survey 2017-2020 dataset were analyzed. MASH and advanced fibrosis (AF) were determined using acMASH and acFibroMASH algorithms, respectively. Liver stiffness measurement (LSM), ALBI grade, and other fibrosis indices were evaluated. Results: Of 566 subjects, 13 (2.3%) were diagnosed with MASH, and 65 (11.48%) had AF. MASH subjects showed significantly higher LSM values compared to non-MASH subjects (p=0.032). ALBI grade demonstrated weak positive correlations with LSM, FIB- 4, and acFibroMASH in non-MASH subjects. The AUROC for ALBI grade in identifying AF was 0.631 (95% CI 0.590-0.671). Multivariate analysis confirmed ALBI grade as an independent predictor of AF (odds ratio 0.193, 95% CI 0.1025-0.2837, p<0.001). Conclusions: ALBI grade shows potential as a non-invasive marker for advanced liver fibrosis in patients with a history of gallstone disease and cholecystectomy, particularly in those with MASH. Further studies with larger MASH cohorts are needed to validate these findings.

INTRODUCTION
METHODS
    1. Data origin and participant selection
    2. Subjects’ data collection
    3. Transient elastography
    4. Non-invasive biomarkers
    5. Participant categorization
    6. Statistical analysis
    7. Ethical approval
RESULTS
    1. Demographic and clinical characteristics
    2. Liver function and fibrosis parameters
    3. Correlation between ALBI grade and fibrosisindexes
    4. ALBI grade as a predictor of advanced liverfibrosis
    5. Subgroup analysis: MASH vs. NM
DISCUSSION
ORCID
ACKNOWLEDGMENTS
AUTHORS’ CONTRIBUTIONS
DATA AVAILABILITY
REFERENCES
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• Mohammadjavad Sotoudeheian(Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran) Corresponding author