Investigation of the Relationship Between Frailty and HALP and PNI Scores in Older Adults

Abstract

Objective: This study aimed to investigate the relationship between frailty and the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a biomarker reflecting nutritional and inflammatory status, and the prognostic nutritional index (PNI), an indicator of nutritional and immunological status, in older adults. Material and Methods: A total of 205 participants aged 65 years and older were included in the study. Frailty was assessed using the clinical frailty scale, the FRAIL scale evaluating fatigue, resistance, ambulation, illnesses, and loss of weight, and the Edmonton Frail Scale. HALP and PNI scores were calculated for all participants and analyzed statistically. Results: According to all frailty scales, HALP and PNI scores were significantly lower in frail individuals (p<0.05 for all comparisons). Both HALP and PNI scores showed significant negative correlations with all frailty scales. In multivariable logistic regression analysis, only the PNI score was independently associated with frailty (Exp(B) = 0.906; 95% CI: 0.84–0.96; p=0.003). Conclusion: This study demonstrates that HALP and PNI scores are significantly associated with frailty in older adults, indicating that biochemical markers may play a complementary role in frailty assessment.

Keywords

• Frailty
• HALP score
• PNI score

YAŞLI YETİŞKİNLERDE KIRILGANLIK İLE HALP VE PNI SKORLARI ARASINDAKİ İLİŞKİNİN İNCELENMESİ

Abstract

Amaç: Bu çalışma, yaşlı bireylerde kırılganlık durumunun; hemoglobin, albümin, lenfosit ve trombosit parametrelerinden oluşan HALP skoru ile, beslenme ve immünolojik durumu değerlendiren prognostik nutrisyonel indeks (PNI) arasındaki ilişkiyi incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya 65 yaş ve üzeri toplam 205 katılımcı dâhil edildi. Kırılganlık değerlendirmesi için klinik kırılganlık ölçeği, yorgunluk (fatigue), direnç (resistance), ambulasyon (ambulation), hastalıklar (illnesses) ve kilo kaybı (loss of weight) bileşenlerini değerlendiren FRAIL ölçeği ve Edmonton Kırılganlık Ölçeği kullanıldı. Tüm katılımcıların HALP ve PNI skorları hesaplanarak istatistiksel analiz yapıldı. Bulgular: Tüm kırılganlık ölçeklerine göre kırılgan bireylerde HALP ve PNI skorları anlamlı olarak daha düşüktü (tüm karşılaştırmalar için p<0,05). HALP ve PNI skorları ile tüm kırılganlık ölçekleri arasında anlamlı negatif korelasyon saptandı. Çok değişkenli lojistik regresyon analizinde yalnızca PNI skorunun kırılganlıkla bağımsız ilişkili olduğu saptandı (Exp(B)=0,906; %95 GA: 0,84-0,96; p=0,003). Sonuç: Bu çalışma, HALP ve PNI skorlarının yaşlı bireylerde kırılganlıkla anlamlı düzeyde ilişkili olduğunu göstererek, biyokimyasal göstergelerin kırılganlık değerlendirmesinde tamamlayıcı bir rol üstlenebileceğine işaret etmektedir.

Keywords

• Kırılganlık
• HALP skoru
• PNI skoru

References

1. Dogra S, Dunstan DW, Sugiyama T, Stathi A, Gardiner PA, Owen N. Active aging and public health: evidence, implications, and opportunities. Annu Rev Public Health. 2022;43(1):439-459.
2. O’Caoimh R, Sezgin D, O’Donovan MR, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing. 2021;50(1):96-104.
3. Marcucci M, Damanti S, Germini F, et al. Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines. BMC Med. 2019;17(1):193.
4. 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.
5. Lien YC, Hsieh CC, Wu YC, et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. Journal of gastrointestinal surgery. 2004;8(8):1041-1048.
6. Koyuncu I, Koyun E. Relationship between HALP and PNI score with 1-month mortality after CABG. Front Nutr. 2024;11:1489301.
7. Kollu K, Yerdelen EA, Duran S, Kabatas B, Karakas F, Kizilarslanoglu MC. Comparison of nutritional risk indices (PNI, GNRI, mNUTRIC) and HALP score in predicting adverse clinical outcomes in older patients staying in an intensive care unit. Medicine. 2024;103(25):e38672.
8. Church S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical Frailty Scale. BMC Geriatr. 2020;20(1):393.

9. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-608.
10. Aygör HE, Fadıloğlu Ç, Şahin S, Aykar FŞ, Akçiçek F. Validation of edmonton frail scale into elderly Turkish population. Arch Gerontol Geriatr. 2018;76:133-137.
11. 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.
12. Yan L, Nakamura T, Casadei-Gardini A, Bruixola G, Huang YL, Hu ZD. Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review. Ann Transl Med. 2021;9(21):1630.
13. Zhou Y, Wang L, Cao A, et al. Modified frailty index combined with a prognostic nutritional index for predicting postoperative complications of hip fracture surgery in elderly. Journal of InvestIgatIve surgery. 2022;35(10):1739-1746.
14. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types. Oncotarget. 2023;14:153.
15. Zhou C, Zhou Y, Wang T, Wang Y, Liang X, Kuang X. Association of Prognostic Nutritional Index (PNI) with All-Cause Mortality and Cardiovascular Mortality: A Nationwide Population-Based Cohort Study. Front Nutr. 2025;12:1530452.
16. De la Garza Ramos R, Ryvlin J, Hamad MK, et al. The prognostic nutritional index (PNI) is independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery. European Spine Journal. 2023;32(12):4328-4334.
17. Don BR, Kaysen G. Poor nutritional status and inflammation: serum albumin: relationship to inflammation and nutrition. In: Seminars in Dialysis. Vol 17. Wiley Online Library; 2004:432-437.
18. Ramel A, Jonsson P V, Bjornsson S, Thorsdottir I. Anemia, nutritional status, and inflammation in hospitalized elderly. Nutrition. 2008;24(11-12):1116-1122.
19. Wang Z, Zhang W, Chen L, Lu X, Tu Y. Lymphopenia in sepsis: a narrative review. Crit Care. 2024;28(1):315.
20. Beaudart C, Buckinx F, Rabenda V, et al. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2014;99(11):4336-4345.
21. Charoenngam N, Holick MF. Immunologic effects of vitamin D on human health and disease. Nutrients. 2020;12(7):2097.
22. Pratumvinit B, De Biasi J, Boonyasit Y, et al. Roles of folate, vitamin B12 and vitamin D in older individuals with frailty. Nutr Res Rev. Published online 2025:1-44.
23. Kuribanjiang K, Min Y, Yan S, et al. A Mendelian randomization study to examine the causal associations of circulating micronutrient levels with frailty risk. Front Nutr. 2024;11:1386646.
24. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):M255-M263.