Research Article
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Year 2025, Volume: 11 Issue: 2, 251 - 259
https://doi.org/10.18621/eurj.1609765

Abstract

References

  • 1. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016;375(13):1303. doi: 10.1056/NEJMc1609622.
  • 2. Hwang MC, Ridley L, Reveille JD. Ankylosing spondylitis risk factors: a systematic literature review. Clin Rheumatol. 2021;40(8):3079-3093. doi: 10.1007/s10067-021-05679-7.
  • 3. He Q, Luo J, Chen J, et al. The validity and reliability of quality of life questionnaires in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and meta-analysis. Health Qual Life Outcomes. 2022;20(1):116. doi: 10.1186/s12955-022-02026-5.
  • 4. Au YL, Wong WS, Mok MY, et al. Disease activity assessment in ankylosing spondylitis in a Chinese cohort: BASDAI or ASDAS? Clin Rheumatol. 2014;33(8):1127-1134. doi: 10.1007/s10067-014-2729-5.
  • 5. Poddubnyy D, Rudwaleit M, Haibel H, et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis. 2011;70(8):1369-1374. doi: 10.1136/ard.2010.145995.
  • 6. Sari I, Haroon N. Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification. Curr Rheumatol Rep. 2018;20(12):82. doi: 10.1007/s11926-018-0795-4.
  • 7. Spoorenberg A, van der Heijde D, de Klerk E, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999;26(4):980-984. PMID: 10229432.
  • 8. Peng D, Zhang CJ, Tang Q, et al. Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy. BMC Urol. 2018;18(1):20. doi: 10.1186/s12894-018-0333-8.
  • 9. Park PG, Yoo BW, Song JJ, Park YB, Lee SW. Will the HALP score help to assess the activity and predict the prognosis of antineutrophil cytoplasmic antibody-associated vasculitis? Clin Exp Rheumatol. 2020;38 Suppl 124(2):236-237.
  • 10. Guo Y, Shi D, Zhang J, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score is a Novel Significant Prognostic Factor for Patients with Metastatic Prostate Cancer Undergoing Cytoreductive Radical Prostatectomy. J Cancer. 2019;10(1):81-91. doi: 10.7150/jca.27210.
  • 11. Ren K, Yin Y, He F, Shao Y, Wang S. Prognostic role of derived neutrophil-to-lymphocyte ratio in surgical triple-negative breast cancer. Cancer Manag Res. 2018;10:4891-4898. doi: 10.2147/CMAR.S180695.
  • 12. Germolec DR, Shipkowski KA, Frawley RP, Evans E. Markers of Inflammation. Methods Mol Biol. 2018;1803:57-79. doi: 10.1007/978-1-4939-8549-4_5.
  • 13. Sariyildiz A, Benlidayi IC, Turk I, Acemoglu SSZ, Unal I. Evaluation of the relationship between blood cell markers and inflammation, disease activity, and general health status in ankylosing spondylitis. Rev Assoc Med Bras (1992). 2023;69(10):e20230722. doi: 10.1590/1806-9282.20230722.
  • 14. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25-31. doi: 10.1136/ard.2010.133645.
  • 15. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int. 2005;25(4):280-284. doi: 10.1007/s00296-003-0432-y.
  • 16. Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S47-58. doi: 10.1002/acr.20575.
  • 17. Kwan YH, Tan JJ, Phang JK, et al. Validity and reliability of the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with axial spondyloarthritis (axSpA) in Singapore. Int J Rheum Dis. 2019;22(12):2206-2212. doi: 10.1111/1756-185X.13735.
  • 18. Chen CH, Chen HA, Liao HT, Liu CH, Tsai CY, Chou CT. The clinical usefulness of ESR, CRP, and disease duration in ankylosing spondylitis: the product of these acute-phase reactants and disease duration is associated with patient's poor physical mobility. Rheumatol Int. 2015;35(7):1263-1267. doi: 10.1007/s00296-015-3214-4.
  • 19. Harpham C, Harpham QK, Barker AR. The effect of exercise training programs with aerobic components on C-reactive protein, erythrocyte sedimentation rate and self-assessed disease activity in people with ankylosing spondylitis: A systematic review and meta-analysis. Int J Rheum Dis. 2022;25(6):635-649. doi: 10.1111/1756-185X.14315.
  • 20. Wallis D, Haroon N, Ayearst R, Carty A, Inman RD. Ankylosing spondylitis and nonradiographic axial spondyloarthritis: part of a common spectrum or distinct diseases? J Rheumatol. 2013;40(12):2038-2041. doi: 10.3899/jrheum.130588.
  • 21. Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol. 2020;26(8):828-838. doi: 10.3748/wjg.v26.i8.828.
  • 22. Tian M, Li Y, Wang X, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Associated With Poor Outcome of Acute Ischemic Stroke. Front Neurol. 2021;11:610318. doi: 10.3389/fneur.2020.610318.
  • 23. Regolo M, Vaccaro M, Sorce A, et al. Neutrophil-to-Lymphocyte Ratio (NLR) Is a Promising Predictor of Mortality and Admission to Intensive Care Unit of COVID-19 Patients. J Clin Med. 2022;11(8):2235. doi: 10.3390/jcm11082235.
  • 24. Xu M, Chen L, Hu Y, et al. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is associated with early-onset post-stroke cognitive impairment. Neurol Sci. 2023;44(1):237-245. doi: 10.1007/s10072-022-06414-z.
  • 25. Han H, Hu S, Du J. Predictive value of the hemoglobin-albumin-lymphocyte-platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Intern Emerg Med. 2023;18(1):85-96. doi: 10.1007/s11739-022-03132-4.
  • 26. Ortega-Rojas S, Salazar-Talla L, Romero-Cerdán A, et al. The Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors of Mortality in Older Adults Hospitalized with COVID-19 in Peru. Dis Markers. 2022;2022:2497202. doi: 10.1155/2022/2497202.
  • 27. Coşkun BN, Öksüz MF, Ermurat S, et al. Neutrophil lymphocyte ratio can be a valuable marker in defining disease activity in patients who have started anti-tumor necrosis factor (TNF) drugs for ankylosing spondylitis. Eur J Rheumatol. 2014;1(3):101-105. doi: 10.5152/eurjrheumatol.2014.034.
  • 28. Zeb A, Khurshid S, Bano S, et al. The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis. Cureus. 2019;11(10):e6025. doi: 10.7759/cureus.6025.
  • 29. Poggiali E, Migone De Amicis M, Motta I. Anemia of chronic disease: a unique defect of iron recycling for many different chronic diseases. Eur J Intern Med. 2014;25(1):12-17. doi: 10.1016/j.ejim.2013.07.011.
  • 30. Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021;35(9):e23964. doi: 10.1002/jcla.23964.
  • 31. Mercan R, Bitik B, Tufan A, et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016;30(5):597-601. doi: 10.1002/jcla.21908.
  • 32. Nam B, Koo BS, Choi N, et al. The impact of smoking status on radiographic progression in patients with ankylosing spondylitis on anti-tumor necrosis factor treatment. Front Med (Lausanne). 2022;9:994797. doi: 10.3389/fmed.2022.994797.
  • 33. Shahabinejad G, Sirati-Sabet M, Kazemi-Arababadi M, Nabati S, Asadikaram G. Effects of Opium Addiction and Cigarette Smoking on Hematological Parameters. Addict Health. 2016;8(3):179-185.

Association between disease activity and HALP score in ankylosing spondylitis patients

Year 2025, Volume: 11 Issue: 2, 251 - 259
https://doi.org/10.18621/eurj.1609765

Abstract

Objective: The goal of this research was to assess HALP score (Hemoglobin, Albumin, Lymphocyte, Platelet) as a potential indicator of disease activity among patients with Ankylosing Spondylitis (AS).

Methods: Data from 260 individuals (130 AS patients and 130 healthy controls) were retrospectively reviewed. Clinical and demographic information was collected, and the AS group was divided into remission and active disease subgroups for comparison.

Results: In contrast to the group of healthy controls, AS patients had a lower HALP score (P<0.001). The HALP score was notably lower in the active patient group than in the remission group (P=0.025). The HALP score and the erythrocyte sedimentation rate were found to be negatively correlated (r=-0.307, P<0.001). Additionally, significant negative correlations were identified between the HALP score and the following parameters: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (r=-0.208, P=0.017), Bath Ankylosing Spondylitis Functional Index (BASFI) (r=-0.195, P=0.026), Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP) (r=-0.199, P=0.024), and Visual Analog Scale (r=-0.229, P=0.009). The optimal HALP score cut-off for determining disease activity was established as ≤0.56 (AUC: 0.619, 95% CI: 0.518-0.721, sensitivity: 80.00%, specificity: 40.00%).

Conclusions: This study found that the HALP score was lower in active AS patients compared to those in remission. Therefore, the HALP score may serve as a potential marker for assessing disease activity in AS patients.

Ethical Statement

Ethical approval was obtained from the Recep Tayyip Erdoğan University Non-Interventional Clinical Research Ethics Committee (Approval date: 18.07.2024 and no: 195). The study was carried out in accordance with the Declaration of Helsinki.

References

  • 1. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016;375(13):1303. doi: 10.1056/NEJMc1609622.
  • 2. Hwang MC, Ridley L, Reveille JD. Ankylosing spondylitis risk factors: a systematic literature review. Clin Rheumatol. 2021;40(8):3079-3093. doi: 10.1007/s10067-021-05679-7.
  • 3. He Q, Luo J, Chen J, et al. The validity and reliability of quality of life questionnaires in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and meta-analysis. Health Qual Life Outcomes. 2022;20(1):116. doi: 10.1186/s12955-022-02026-5.
  • 4. Au YL, Wong WS, Mok MY, et al. Disease activity assessment in ankylosing spondylitis in a Chinese cohort: BASDAI or ASDAS? Clin Rheumatol. 2014;33(8):1127-1134. doi: 10.1007/s10067-014-2729-5.
  • 5. Poddubnyy D, Rudwaleit M, Haibel H, et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis. 2011;70(8):1369-1374. doi: 10.1136/ard.2010.145995.
  • 6. Sari I, Haroon N. Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification. Curr Rheumatol Rep. 2018;20(12):82. doi: 10.1007/s11926-018-0795-4.
  • 7. Spoorenberg A, van der Heijde D, de Klerk E, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999;26(4):980-984. PMID: 10229432.
  • 8. Peng D, Zhang CJ, Tang Q, et al. Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy. BMC Urol. 2018;18(1):20. doi: 10.1186/s12894-018-0333-8.
  • 9. Park PG, Yoo BW, Song JJ, Park YB, Lee SW. Will the HALP score help to assess the activity and predict the prognosis of antineutrophil cytoplasmic antibody-associated vasculitis? Clin Exp Rheumatol. 2020;38 Suppl 124(2):236-237.
  • 10. Guo Y, Shi D, Zhang J, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score is a Novel Significant Prognostic Factor for Patients with Metastatic Prostate Cancer Undergoing Cytoreductive Radical Prostatectomy. J Cancer. 2019;10(1):81-91. doi: 10.7150/jca.27210.
  • 11. Ren K, Yin Y, He F, Shao Y, Wang S. Prognostic role of derived neutrophil-to-lymphocyte ratio in surgical triple-negative breast cancer. Cancer Manag Res. 2018;10:4891-4898. doi: 10.2147/CMAR.S180695.
  • 12. Germolec DR, Shipkowski KA, Frawley RP, Evans E. Markers of Inflammation. Methods Mol Biol. 2018;1803:57-79. doi: 10.1007/978-1-4939-8549-4_5.
  • 13. Sariyildiz A, Benlidayi IC, Turk I, Acemoglu SSZ, Unal I. Evaluation of the relationship between blood cell markers and inflammation, disease activity, and general health status in ankylosing spondylitis. Rev Assoc Med Bras (1992). 2023;69(10):e20230722. doi: 10.1590/1806-9282.20230722.
  • 14. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25-31. doi: 10.1136/ard.2010.133645.
  • 15. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int. 2005;25(4):280-284. doi: 10.1007/s00296-003-0432-y.
  • 16. Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S47-58. doi: 10.1002/acr.20575.
  • 17. Kwan YH, Tan JJ, Phang JK, et al. Validity and reliability of the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with axial spondyloarthritis (axSpA) in Singapore. Int J Rheum Dis. 2019;22(12):2206-2212. doi: 10.1111/1756-185X.13735.
  • 18. Chen CH, Chen HA, Liao HT, Liu CH, Tsai CY, Chou CT. The clinical usefulness of ESR, CRP, and disease duration in ankylosing spondylitis: the product of these acute-phase reactants and disease duration is associated with patient's poor physical mobility. Rheumatol Int. 2015;35(7):1263-1267. doi: 10.1007/s00296-015-3214-4.
  • 19. Harpham C, Harpham QK, Barker AR. The effect of exercise training programs with aerobic components on C-reactive protein, erythrocyte sedimentation rate and self-assessed disease activity in people with ankylosing spondylitis: A systematic review and meta-analysis. Int J Rheum Dis. 2022;25(6):635-649. doi: 10.1111/1756-185X.14315.
  • 20. Wallis D, Haroon N, Ayearst R, Carty A, Inman RD. Ankylosing spondylitis and nonradiographic axial spondyloarthritis: part of a common spectrum or distinct diseases? J Rheumatol. 2013;40(12):2038-2041. doi: 10.3899/jrheum.130588.
  • 21. Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol. 2020;26(8):828-838. doi: 10.3748/wjg.v26.i8.828.
  • 22. Tian M, Li Y, Wang X, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Associated With Poor Outcome of Acute Ischemic Stroke. Front Neurol. 2021;11:610318. doi: 10.3389/fneur.2020.610318.
  • 23. Regolo M, Vaccaro M, Sorce A, et al. Neutrophil-to-Lymphocyte Ratio (NLR) Is a Promising Predictor of Mortality and Admission to Intensive Care Unit of COVID-19 Patients. J Clin Med. 2022;11(8):2235. doi: 10.3390/jcm11082235.
  • 24. Xu M, Chen L, Hu Y, et al. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is associated with early-onset post-stroke cognitive impairment. Neurol Sci. 2023;44(1):237-245. doi: 10.1007/s10072-022-06414-z.
  • 25. Han H, Hu S, Du J. Predictive value of the hemoglobin-albumin-lymphocyte-platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Intern Emerg Med. 2023;18(1):85-96. doi: 10.1007/s11739-022-03132-4.
  • 26. Ortega-Rojas S, Salazar-Talla L, Romero-Cerdán A, et al. The Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors of Mortality in Older Adults Hospitalized with COVID-19 in Peru. Dis Markers. 2022;2022:2497202. doi: 10.1155/2022/2497202.
  • 27. Coşkun BN, Öksüz MF, Ermurat S, et al. Neutrophil lymphocyte ratio can be a valuable marker in defining disease activity in patients who have started anti-tumor necrosis factor (TNF) drugs for ankylosing spondylitis. Eur J Rheumatol. 2014;1(3):101-105. doi: 10.5152/eurjrheumatol.2014.034.
  • 28. Zeb A, Khurshid S, Bano S, et al. The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis. Cureus. 2019;11(10):e6025. doi: 10.7759/cureus.6025.
  • 29. Poggiali E, Migone De Amicis M, Motta I. Anemia of chronic disease: a unique defect of iron recycling for many different chronic diseases. Eur J Intern Med. 2014;25(1):12-17. doi: 10.1016/j.ejim.2013.07.011.
  • 30. Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021;35(9):e23964. doi: 10.1002/jcla.23964.
  • 31. Mercan R, Bitik B, Tufan A, et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016;30(5):597-601. doi: 10.1002/jcla.21908.
  • 32. Nam B, Koo BS, Choi N, et al. The impact of smoking status on radiographic progression in patients with ankylosing spondylitis on anti-tumor necrosis factor treatment. Front Med (Lausanne). 2022;9:994797. doi: 10.3389/fmed.2022.994797.
  • 33. Shahabinejad G, Sirati-Sabet M, Kazemi-Arababadi M, Nabati S, Asadikaram G. Effects of Opium Addiction and Cigarette Smoking on Hematological Parameters. Addict Health. 2016;8(3):179-185.
There are 33 citations in total.

Details

Primary Language English
Subjects Rheumatology and Arthritis
Journal Section Original Articles
Authors

Osman Cüre 0000-0001-5848-6363

Early Pub Date February 7, 2025
Publication Date
Submission Date December 30, 2024
Acceptance Date January 26, 2025
Published in Issue Year 2025 Volume: 11 Issue: 2

Cite

AMA Cüre O. Association between disease activity and HALP score in ankylosing spondylitis patients. Eur Res J. 11(2):251-259. doi:10.18621/eurj.1609765

e-ISSN: 2149-3189 


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