Background: In many health systems, primary care is the main source of health care services. Liver cirrhosis is a silent disease that causes no signs or symptoms until decompensation occurs. Therefore, a simple and readily accessible tool for predicting advanced liver fibrosis and cirrhosis is needed to aid general practitioners in primary care settings. Aim: To explore the predictive performance of Albumin Bilirubin (ALBI) score as a non-invasive serum biomarker for advanced liver fibrosis and cirrhosis. Methods: This case-control study was conducted at Zagazig University Hospitals, Egypt, and comprised 400 participants divided into two equal groups. Group (I): 200 chronic HCV patients with advanced liver fibrosis and cirrhosis [F3-F4], and Group (II): 200 healthy controls. ALBI score was calculated for all study participants. Results: The AUROC for the ALBI score was 0.832 (95% CI: 0.787-0.872) (p-value <0.001), sensitivity= 74.8%, specificity= 80.2%, PPV= 86.8%, NPV =64.6%, and positive likelihood ratio=3.77. The cut-off value to differentiate chronic HCV patients with advanced liver fibrosis and cirrhosis from healthy controls was -2.781. Sub-group analysis of chronic HCV cases showed a statistically significant difference in the mean ALBI score between (F3) and (F4) cases (p-value<0.0001) with an AUROC of 0.654 (p-value=0.028). Conclusion: ALBI score is reliable for predicting advanced liver fibrosis and cirrhosis and could be valuable in primary care.