HALP Skorunun Solunum Problemiyle Yatışı Yapılan Çok Yaşlı Hastalarda Hastane İçi Mortalite Riskinin Tahminindeki Rolü

Year 2025, Volume: 27 Issue: 3 , 378 - 385 , 25.12.2025

Makbule Özlem Akbay , Dilek Ernam

https://doi.org/10.24938/kutfd.1804956

https://izlik.org/JA22FL29MJ

Abstract

Amaç: Bu çalışmada hemoglobin ve albümin düzeyleri ve lenfosit ve trombosit sayımını birlikte içeren yeni bir skor olarak HALP skorunun solunum problemiyle yatışı yapılan çok yaşlı hastalarda hastane içi mortalite riskinin tahminindeki rolünün incelenmesi amaçlandı.
Gereç ve Yöntemler: Bu tek-merkezli retrospektif kohort çalışmasına solunum problemi ile yatışı yapılan toplam 2011 çok yaşlı (80 yaş üzeri) hasta dahil edildi. Hospitalizasyon nedeni, komorbiditeler, yatışın ilk günü yapılan tam kan sayımı ve biyokimya testi sonuçları, hastanede kalış süresi (HKS) ve hastane içi mortalite verileri kaydedildi. Hastane içi mortalitenin belirleyicileri tek-değişkenli ve çok-değişkenli Cox regresyon analizi ile saptandı. HALP skorunun hastane içi mortaliteyi tahmin etmedeki performansı ROC eğrisi analizi ile belirlendi.
Bulgular: Medyan hasta yaşı 83 yıl (80-108 yaş aralığında) olup, çalışma popülasyonundaki erkek hastaların oranı %51,6 idi. Hastane içi mortalite oranı %7 olarak bulundu. Çok-değişkenli analizde, düşük HALP skoru (HR 0,693, %95 GA: 0,549-0,875, p=0,002), erkek cinsiyet (HR 0,654, %95 GA: 0,453-0,945, p=0,024) ve yüksek C-reaktif protein (CRP) değeri (HR 1,004, %95 GA: 1,002-1,006, p<0,001) hastane içi mortalite riskinin anlamlı belirleyicileri olarak bulundu. Medyan HKS 7 gün idi. HALP skorları ve HKS arasında anlamlı negatif korelasyon (r=-0,153, p<0,001) tespit edildi. ROC analizi sonuçları HALP skorunun ≤13,7 kesim değerinde (AUC: 0,706, %95 GA: 0,685-0,726, p<0,001) ve %60,7 sensitivite ve %69,8 spesifisite ile solunum problemi ile yatışı yapılan çok yaşlı hastalarda hastane içi mortalitenin potansiyel bir belirteci olduğunu gösterdi.
Sonuç: Solunum problemi ile yatışı yapılan çok yaşlı hastalarda hastane içi mortalitenin bağımsız prognostik bir faktörü olarak, HALP skorunun kullanılması, klinisyenlere risk altındaki hastaların zamanında tespitinde ve girişimlere yönelik stratejik karar almada yardımcı olabilir.

Keywords

HALP skoru , solunum problemi ile hospitalizasyon , hastane içi mortalite , çok yaşlı hastalar

THE PERFORMANCE OF HALP SCORE IN PREDICTING IN-HOSPITAL MORTALITY RISK AMONG VERY ELDERLY PATIENTS WITH RESPIRATORY-RELATED HOSPITALIZATION

https://izlik.org/JA22FL29MJ

Abstract

Objective: This study aimed to investigate the performance of the novel score combining hemoglobin and albumin levels and lymphocyte and platelet count (HALP) in predicting in-hospital mortality risk in very elderly patients with respiratory-related hospitalization.
Material and Methods: A total of 2011 very elderly (over 80 years) patients with respiratory-related hospitalization were included in this single-center retrospective cohort study. Reason for hospitalization, comorbidities, complete blood count and biochemistry findings on the first day of hospital admission, length of hospital stay (LOS), and in-hospital mortality were recorded. Factors predicting in-hospital mortality risk were analyzed via the univariate and multivariate Cox regression analyses. The ROC curve analysis was performed to determine the performance of HALP score in predicting the in-hospital mortality risk.
Results: The median age was 83 years (range, 80 to 108 years) and males comprised 51.6% of the study population. The in-hospital mortality rate was 7%. The lower HALP score (HR 0.693, 95% CI: 0.549 to 0.875, p=0.002), male gender (HR 0.654, 95% CI: 0.453 to 0.945, p=0.024), and higher C-reactive protein (CRP) values (HR 1.004, 95% CI: 1.002 to 1.006, p<0.001) were found to predict the increased risk of in-hospital mortality on multivariate analysis. The median LOS was 7 days. There was a significant negative correlation between HALP scores and LOS (r=-0.153, p<0.001). ROC analysis revealed the HALP score to be a potential marker of in-hospital mortality risk in very elderly patients with respiratory-related hospitalization, at a cut-off value of ≤13.7 (AUC: 0.706, 95% CI: 0.685 to 0.726, p<0.001) and with a sensitivity of 60.7% and specificity of 69.8%.
Conclusion: As an independent prognostic factor of in-hospital mortality risk in very elderly patients with respiratory-related hospitalization, the use of the HALP score may aid clinicians in timely recognition of at-risk patients and in making strategic decisions for interventions.

Keywords

HALP score , respiratory-related hospitalization , in-hospital mortality , very elderly patients

Ethical Statement

This study was approved by the University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital Ethics Committee (Date of Approval: 13.05.2024, Protocol no: 2024-4).

Supporting Institution

No financial support was received from any institution or person.

References

• United Nations Department of Economic and Social Affairs, Population Division (UN DESA). World Population Ageing 2023: Challenges and opportunities of population aging in the least developed countries. UN DESA/ POP/2023/TR/NO.5. 2023. Accessed date: 21 May 2024: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_2024_wpa2023-report.pdf.
• Dülger D, Albuz Ö. Risk indices that predict in-hospital mortality of elderly patients. Turk J Med Sci. 2020;50(4):969-977.
• Oruç Ö, Morali T, Karakurt Z, et al. Hospitalization and mortality rates in patients with respiratory diseases in the very elderly population. J Gerontol Geriatr Res. 2016;5(2):1000293.
• Hazar A, Gundogus B. Assessment of inflammatory markers, disease severity, and comorbidities in very elderly patients with acute respiratory diseases. Arch Med Sci. 2020;21(2):451-462.
• Tal S. Mortality predictors in the oldest-old in an acute geriatric ward. Isr Med Assoc J. 2022;24(10):638-642.
• 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):41370-41382.
• Güç ZG, Alacacıoğlu A, Kalender ME, et al. HALP score and GNRI: Simple and easily accessible indexes for predicting prognosis in advanced stage NSCLC patients. The İzmir oncology group (IZOG) study. Front Nutr. 2022;9:905292.
• Li H, Zhou Y, Zhang X, Yao R, Li N. The relationship between hemoglobin, albumin, lymphocyte, and platelet (HALP) score and 28-day mortality in patients with sepsis: A retrospective analysis of the MIMIC-IV database. BMC Infect Dis. 2025;25(1):333.
• Wu W, Lu W, Hong D, Yu X, Xiong L. Association between hemoglobin-albumin-lymphocyte-platelet index and mortality in hospitalized COVID-19 Omicron BA.2 infected patients. Infect Drug Resist. 2024;17:1467-1476.
• Kerschbaum M, Klute L, Henssler L, Rupp M, Alt V, Lang S. Risk factors for in-hospital mortality in geriatric patients aged 80 and older with axis fractures: A nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 10,077 cases. Eur Spine J. 2024;33(1):185-197.
• 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.
• Çolak M, Çoban H, Sarioğlu N, Yumrukuz Şenel M, Erel F. Could the HALP score serve as a biomarker of bronchiectasis exacerbation? TuberkToraks. 2024;72(1):9-15.
• Cacciatore F, Gaudiosi C, Mazzella F, et al. Pneumonia and hospitalizations in the elderly. Geriatr Care. 2017;3(6377):20-28.
• Zhou R, Pan D. Association between admission heart rate and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: A retrospective cohort study. BMC Pulm Med. 2024;24(1):111.
• Ayrancı MK, Küçükceran K, Dundar ZD. NLR and CRP to albumin ratio as a predictor of in-hospital mortality in geriatric ED patients. Am J Emerg Med. 2021;44:50-55.
• Bortolani A, Fantin F, Giani A, et al. Predictors of hospital readmission rate in geriatric patients. Aging Clin Exp Res. 2024;36(1):22.
• Zuo L, Dong Y, Liao X, et al. Low HALP (hemoglobin, albumin, lymphocyte, and platelet) score increases the risk of post-stroke cognitive impairment: A multicenter cohort study. Clin Interv Aging. 2024;19:81-92.
• Shen XB, Zhang YX, Wang W, Pan YY. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score in patients with small cell lung cancer before first-line treatment with etoposide and progression-free survival. Med Sci Monit. 2019;25:5630-5639.
• 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.
• 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.
• Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low albumin levels are associated with mortality risk in hospitalized patients. Am J Med. 2017;130(12):1465.
• Caro J, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: A systemic, quantitative review. Cancer. 2001;91(12):2214-2221.
• 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.
• Barlas RS, Honney K, Loke YK, et al. Impact of hemoglobin levels and anemia on mortality in acute stroke: Analysis of UK regional registry data, systematic review, and meta-analysis. J Am Heart Assoc. 2016;5(8):e003019.
• Norman K, Haß U, Pirlich M. Malnutrition in older adults-Recent advances and remaining challenges. Nutrients. 2021;13(8):2764.
• Mostafa N, Sayed A, Rashad O, Baqal O. Malnutrition-related mortality trends in older adults in the United States from 1999 to 2020. BMC Med. 2023;21(1):421.
• Zamora RJ, Chavin H, Regazzoni CJ, Pisarevsky AA, Petrucci E, Poderoso JJ. Nutritional status, systemic inflammatory response syndrome and mortality in the elderly hospitalized patient. Medicina. 2010;70(3):233-239.
• Cerri AP, Bellelli G, Mazzone A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes. Clin Nutr. 2015;34(4):745-751.
• Incalzi RA, Capparella O, Gemma A, et al. The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. J Intern Med. 1997;242(4):291-298.
• Shi X, Shen Y, Yang J, Du W, Yang J. The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study. Heart Lung. 2021;50(6):898-905.
• Chen L, Chen L, Zheng H, Wu S, Wang S. Emergency admission parameters for predicting in-hospital mortality in patients with acute exacerbations of chronic obstructive pulmonary disease with hypercapnic respiratory failure. BMC Pulm Med. 2021;21(1):258.
• Chen L, Huang Z, Lu J,, et al. Impact of the malnutrition on mortality in elderly patients undergoing percutaneous coronary intervention. Clin Interv Aging. 2021;16:1347-1356.
• Nakagomi A, Kohashi K, Morisawa T, et al. Nutritional status is associated with inflammation and predicts a poor outcome in patients with chronic heart failure. J Atheroscler Thromb. 2016;23(6):713-727.
• Hubbard RE, Rockwood K. Frailty in older women. Maturitas. 2011;69(3):203-207.
• Chongthanadon B, Thirawattanasoot N, Ruangsomboon O. Clinical factors associated with in-hospital mortality in elderly versus non-elderly pneumonia patients in the emergency department. BMC Pulm Med. 2023;23(1):330.
• Nguyen NT, Chinn J, De Ferrante M, Kirby KA, Hohmann SF, Amin A. Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS One. 2021;16(7):e0254066.
• Taneja V. Sex hormones determine immune response. Front Immunol. 2018;9:1931.
• Maia FOM, Duarte YAO, Lebrão ML, Santos JLF. Risk factors for mortality among elderly people. Rev Saude Publica. 2006;40(6):1049-1056.
• Byrne DG, Chung SL, Bennett K, Silke B. Age and outcome in acute emergency medical admissions. Age Ageing. 2010;39(6):694-698.
• Szakmany T, Hollinghurst J, Pugh R, et al. Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales. Sci Rep. 2021;11(1):13407.