Association Between HALP Score and Long-Term Mortality in Heart Failure Patients with Reduced Ejection Fraction

Abstract

Aim: Heart failure (HF), especially heart failure with reduced ejection fraction (HFrEF), is a clinical condition with high incidence, mortality, and morbidity worldwide. Therefore, the prognostic evaluation of these patients is of critical importance. Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) Score is a new measurement that has been shown to have prognostic importance in many diseases. This study aimed to investigate the relationship between HALP score and mortality in HFrEF patients. Materials and Methods: This study is a retrospective analysis including patients followed up with a diagnosis of HFrEF between 2017 and 2023. Patients were evaluated in terms of long-term mortality. Cox regression analyses were performed to determine the independent predictive value of HALP score in predicting mortality in HFrEF patients. The discriminatory ability of independent predictors was assessed by determining receiver operating characteristic (ROC) curves and area under the curve (AUC). Results: In our study of 886 patients, the mortality rate was 9.8% (87 patients). The mean age of the patients was 68.7±12.6 years, 529 (59.7%) were male gender, and the mean follow-up period was 2282 days. Gender, aspartate transaminase, creatinine and HALP score (OR: 0.828, 95% CI: 0.737–0.929, p=0.001) were observed as independent predictors of mortality. In addition, it was observed that HALP Score predicted mortality with 60.5% sensitivity and specificity at a cut-off value of 4.96 (AUC: 0.667, 95% CI: 0.605–0.731, p<0.001). Conclusion: In this study, it was observed that HALP score was associated with increased mortality rates in patients with HFrEF, independently of other factors. The HALP score is an economic and convenient marker that can be calculated quickly and effortlessly from standard assessments. It may provide significant benefits in stratifying high-risk patients, determining treatment plan, predicting mortality and evaluating prognosis in HFrEF patients.

Keywords

• anemia
• inflammation
• HALP score
• heart failure; malnutrition; mortality

References

1. 1. Metra M, Teerlink JR. 2017;390(10106):1981–1995. Heart failure. Lancet.
2. 2. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263–e421.
3. 3. Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272–87.
4. 4. McDonagh TA, Metra M, Adamo M, et al. Corrigendum to:2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42(48):4901.
5. 5. Murphy SP, Kakkar R, McCarthy CP, Januzzi JL, Jr. Inflammation in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(11):1324–1340.
6. 6. Matsumoto H, Kasai T, Sato A, et al. Association between C-reactive protein levels at hospital admission and long-term mortality in patients with acute decompensated heart failure. Heart Vessels. 2019;34(12):1961–8
7. 7. Lee ZY, Heyland DK. Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations? Nutr Clin Pract. 2019;34(1):96–111.
8. 8. Silverberg DS, Wexler D, Blum M, et al. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol. 2000;35(7):1737–44.

9. 9. Majmundar M, Kansara T, Park H, et al. Absolute lymphocyte count as a predictor of mortality and readmission in heart failure hospitalization. Int J Cardiol Heart Vasc. 2022;39:100981.
10. 10. Reininger AJ, Bernlochner I, Penz SM, et al. A 2-step mechanism of arterial thrombus formation induced by human atherosclerotic plaques. J Am Coll Cardiol. 2010;55(11):1147–58.
11. 11. Pan H, Lin S. Association of hemoglobin, albumin, lymphocyte, and platelet score with risk of cerebrovascular, cardiovascular, and all-cause mortality in the general population: results from the NHANES 1999–2018. Front Endocrinol (Lausanne) 2023;14:1173399.
12. 12. Xu H, Zheng X, Ai J, Yang L. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13, 110 patients. Int Immunopharmacol. 2023;114:109496.
13. 13. 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. 2020;11:610318.
14. 14. Authors/Task Force M, McDonagh TA, Metra M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24(1):4–131.
15. 15. 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):828–38.
16. 16. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39 e14.
17. 17. Xu M, Chen L, Hu Y, et al. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is associated with early-onset poststroke cognitive impairment. Neurol Sci. 2023;44(1):237–45.
18. 18. Antar R, Farag C, Xu V, Drouaud A, Gordon O, Whalen MJ. Evaluating the baseline hemoglobin, albumin, lymphocyte, and platelet (HALP) score in the United States adult population and comorbidities: an analysis of the NHANES. Front Nutr. 2023;10:1206958.
19. 19. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370–82.
20. 20. Toprak K, Toprak IH, Acar O, Ermis MF. The predictive value of the HALP score for no-reflow phenomenon and short-term mortality in patients with ST-elevation myocardial infarction. Postgrad Med. 2024;136(2):169–79.
21. 21. Kocaoglu S, Alatli T. The Efficiency of the HALP Score and the Modified HALP Score in Predicting Mortality in Patients with Acute Heart Failure Presenting to the Emergency Department. J Coll Physicians Surg Pak. 2022;32(6):706–11.
22. 22. Yilmaz R, Toprak K, Yilmaz M, Karagoz A, Oz E. Investigation of the Usefulness of HALP Score in Predicting Short-Term Mortality in Patients with Acute Decompensated Heart Failure in a Coronary Care Unit. Medicina (Kaunas) 2024;60(9). 1385.
23. 23. Liu L, Gong B, Wang W, Xu K, Wang K, Song G. Association between haemoglobin, albumin, lymphocytes, and platelets and mortality in patients with heart failure. ESC Heart Fail. 2024;11(2):1051–60.
24. 24. Cheng YL, Sung SH, Cheng HM, et al. Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure. J Am Heart Assoc. 2017;6(6):e004876.
25. 25. Angkananard T, Inthanoo T, Sricholwattana S, Rattanajaruskul N, Wongsoasu A, Roongsangmanoon W. The Predictive role of Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume-to-Lymphocyte Ratio (MPVLR) for Cardiovascular Events in Adult Patients with Acute Heart Failure. Mediators Inflamm. 2021;2021:6889733.
26. 26. Klip IT, Postmus D, Voors AA, et al. Hemoglobin levels and new-onset heart failure in the community. Am Heart J. 2015;169(1):94–101 e2.
27. 27. Feng KY, Ambrosy AP, Zhou Z, et al. Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial. Eur J Heart Fail. 2023;25(4):553–61.
28. 28. Vaduganathan M, Ambrosy AP, Greene SJ, et al. Predictive value of low relative lymphocyte count in patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial. Circ Heart Fail. 2012;5(6):750–8.
29. 29. Chung I, Lip GY. Platelets and heart failure. Eur Heart J. 2006;27(22):2623–31.
30. 30. Eckart A, Struja T, Kutz A, et al. Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study. Am J Med. 2020;133(6):713–722 e7.
31. 31. Ganz T. Anemia of Inflammation. N Engl J Med. 2019;381(12):1148–57.
32. 32. Xia H, Shen H, Cha W, Lu Q. The Prognostic Significance of Anemia in Patients With Heart Failure: A Meta-Analysis of Studies From the Last Decade. Front Cardiovasc Med. 2021;8:632318.
33. 33. Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Low serum albumin: A neglected predictor in patients with cardiovascular disease. Eur J Intern Med. 2022;102:24–39.
34. 34. Driggin E, Cohen LP, Gallagher D, et al. Nutrition Assessment and Dietary Interventions in Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol. 2022;79(16):1623–35.
35. 35. Chao P, Cui X, Wang S, Zhang L, Ma Q, Zhang X. Serum albumin and the short-term mortality in individuals with congestive heart failure in intensive care unit: an analysis of MIMIC. Sci Rep. 2022;12(1):16251.
36. 36. Bian C, Wu Y, Shi Y, et al. Predictive value of the relative lymphocyte count in coronary heart disease. Heart Vessels. 2010;25(6):469–73.
37. 37. Formiga F, Chivite D, Salvatori M, Moreno-Gonzalez R, Ariza A, Corbella X. Lymphocyte-to-white blood cells ratio in older patients experiencing a first acute heart failure hospitalization. Eur Geriatr Med. 2018;9(3):365–70.
38. 38. Hsiao YC, Shen PY, Wong LT, Chan MC, Chao WC. The Association Between Absolute Lymphocyte Count and LongTerm Mortality in Critically Ill Medical Patients: Propensity Score-Based Analyses. Int J Gen Med. 2023;16:3665–75.
39. 39. Zheng Y, Huang Y, Li H. Hemoglobin albumin lymphocyte and platelet score and all-cause mortality in coronary heart disease: a retrospective cohort study of NHANES database. Front Cardiovasc Med. 2023;10:1241217.
40. 40. Wang L, Liu T, Zhu Z, et al. Associations between static and dynamic changes of platelet counts and in-hospital mortality in critical patients with acute heart failure. Sci Rep. 2024;14(1):9147