The role of HALP and modified HALP scores in predicting in-hospital mortality in patients with low ejection fraction heart failure presenting with acute decompensation
N Turan Serifler, M E L T E M Altinsoy, A R Z U N Akgun, T U G B A Kayhan AltunerAbstract
Objective
Patients with heart failure and a low ejection fraction who are hospitalized because of acute decompensation are at a significant risk of dying early, and we need practical markers that can accurately predict this risk. The HALP score, which measures nutritional and hematological state, has been suggested for this purpose, however its predictive validity may be constrained by the exclusion of inflammatory burden. In this study, we examined the correlation between the modified HALP (HALP/CRP) score an inflammation-adjusted variant of the HALP score and in-hospital mortality, and we evaluated its efficacy relative to the traditional HALP score.
Methods
This retrospective observational study encompassed 474 individuals admitted with a diagnosis of acute decompensated low ejection fraction heart failure. Demographic parameters, clinical data, laboratory results, echocardiographic measures, and therapy information have been collected from medical records. The HALP score was computed utilizing hemoglobin, albumin, lymphocyte, and platelet metrics; the modified HALP score was obtained by dividing the HALP value by C-reactive protein (CRP). The primary endpoint was in-hospital mortality. Univariate and multivariate logistic regression analysis were conducted to ascertain determinants of mortality. Receiver operating characteristic (ROC) curve analysis was used to check how well the test could tell the difference between groups, and the Youden index was used to find the best cut-off values.
Results
During hospitalization, 20.9% of the study population died. Compared with survivors, non-survivors were older and had higher NT-proBNP and CRP levels, while albumin, hemoglobin, HALP, and modified HALP scores were significantly lower. In univariate analysis, age, NT-proBNP, CRP, HALP, and modified HALP scores were associated with in-hospital mortality, whereas ejection fraction, length of hospital stay, etiology, and the presence of cardiac devices were not. In multivariate analysis adjusted for age, sex, and NT-proBNP, the modified HALP score remained an independent predictor of in-hospital mortality, while the HALP score lost its independent significance. ROC analysis demonstrated that the discriminative ability of the modified HALP score was superior to that of the HALP score (AUC 0.76 vs. 0.63). A cut-off value of ≤0.0040 for the modified HALP score yielded a sensitivity of 68.7% and a specificity of 82.1%.
Conclusion
In patients with acute decompensated heart failure characterized by low ejection fraction, the modified HALP score performs as a strong and independent prognostic marker for predicting in-hospital mortality. Combining inflammatory status with nutrition and hematological parameters can improve the accuracy of short-term mortality risk classification.tables 1–3. main study tablesFor image description, please refer to the figure legend and surrounding text.ROC curves of HALP and modified HALP (HAFor image description, please refer to the figure legend and surrounding text.