The Value of The Halp Score in Predicting The Severity of Coronary Artery Disease

Öz

Background: Coronary artery disease (CAD) is the leading cause of death in both developed and developing countries. Atherosclerosis is a chronic inflammatory process. The HALP score, which includes measurements of hemoglobin, albumin, lymphocyte and platelet levels, has recently been recognized as a practical and easy-to-use tool to assess both systemic inflammation and nutritional status. In this study, we aimed to investigate the value of the HALP score in predicting the severity of CAD. Materials and Methods: The study included 450 patients who underwent coronary angiography (CAG) due to suspected CAD between June 2023 and February 2025 in our clinic retrospectively. Patients were catego-rized into normal, mild and severe coronary atherosclerosis using the Gensini scoring for the grading of CAD. The HALP score was calculated from the complete blood count and biochemical data obtained before CAG. Results: Patients were divided into two groups according to the median HALP cut-off value of 52.05. Patients with a cut-off value greater than 52.05 were defined as high HALP score and those with a cut-off value less than 52.05 were defined as low HALP score. The Gensini score was significantly higher in the group with a low HALP score compared to the group with a high HALP score (p=0.02). Additionally, the HALP score was found to decrease significantly as the severity of CAD increased according to the Gensini score (p=0.01). Correlation analysis revealed that the HALP score was negatively correlated with the Gensini score (r= -0.526, p<0.001). Regression analysis revealed that the HALP score was an independent predictor of the Gensini score (Ꞵ=-0.37, t= -2.12, p<0.001). Conclusions: This study demonstrated that the HALP score may be a useful indicator for predicting the sever-ity of CAD.

Anahtar Kelimeler

• HALP score
• coronary angiography
• coronary artery disease

HALP Skorunun Koroner Arter Hastalığının Şiddetini Öngörmedeki Değeri

Öz

Amaç: Koroner arter hastalığı (KAH), hem gelişmiş hem de gelişmekte olan ülkelerde önde gelen ölüm nedenidir. Ateroskleroz kronik bir inflamatuvar süreçtir. Hemoglobin, albümin, lenfosit ve trombosit düzeylerinin ölçümlerini içeren HALP skoru, son zamanlarda hem sistemik inflamasyonu hem de beslenme durumunu değerlendirmek için pratik ve kullanımı kolay bir araç olarak kabul edilmiştir. Bu çalışmada, HALP skorunun KAH’ın şiddetini öngörmedeki değerini araştırmayı amaçladık. Materyal ve metod: Çalışmaya, Haziran 2023 ile Şubat 2025 arasında kliniğimizde şüpheli KAH nedeniyle koroner anjiyografi (KAG) uygulanan 450 ardışık hasta, retrospektif olarak dahil edildi. Hastalar, KAH ciddiyetinin derecelendirilmesi için Gensini skorlaması kullanılarak normal, hafif ve şiddetli koroner ateroskleroz olarak kategorize edildi. HALP skoru, KAG'den önce elde edilen tam kan sayımı ve biyokimyasal verilerden hesaplandı. Bulgular: Hastalar, medyan HALP kesme değeri olan 52.05'e göre iki gruba ayrıldı. Kesme değeri 52.05'ten büyük olan hastalar yüksek HALP skoru, kesme değeri 52.05'ten küçük olan hastalar ise düşük HALP skoru olarak tanımlandı. HALP skoru düşük olan grupta HALP skoru yüksek olan gruba göre Gensini skoru anlamlı olarak daha yüksek idi (p=0.02). Ek olarak, Gensini skoruna göre KAH ciddiyeti arrtıkça HALP skorunun da anlamlı olarak azaldığı tespit edildi (p=0.01). Yapılan korelasyon analizinde HALP skorunun Gensini skoru ile negatif bir şekilde korele olduğu tespit edildi (r= -0.526, p< 0.001). Yapılan regresyon analizinde HALP skoru, Gensini skorunun bağımsız bir öngördürücüsü olarak tespit edildi (β = –0.37, p < 0.001). Sonuç: Bu çalışma, HALP skorunun KAH’ın şiddetini öngörmede yararlı bir gösterge olabileceğini göstermiştir

Anahtar Kelimeler

• HALP skoru
• koroner anjiyografi
• koroner arter hastalığı

Etik Beyan

Harran Üniversitesi Klinik Araştırmalar Etik kurulundan 24.03.2025 tarihinde HRÜ/25.06.17 sayılı etik kurulu alınmıştır.

Kaynakça

1. 1. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk fac-tors, and therapeutics. J Cell Physiol. 2019;234(10):16812-16823.
2. 2. Badimon L, Padró T, Vilahur G. Atherosclerosis, platelets and thrombosis in acute ischaemic heart disease. Eur Heart J Acute Cardiovasc Care. 2012;1(1):60-74.
3. 3. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477.
4. 4. Guclu K, Celik M. Prognostic Value of Inflammation Parameters in Patients With Non-ST Elevation Acute Coronary Syndromes. Angiology. 2020;71(9):825-830.
5. 5. Fan W, Zhang Y, Liu Y, Ding Z, Si Y, Shi F, et al. Nomograms based on the advanced lung cancer inflammation index for the prediction of coronary artery disease and calcification. Clin Appl Thromb Hemost. 2021;27:1-11.
6. 6. Peng D, Zhang CJ, Gong YQ, Hao H, Guan B, Li XS, et al. Prognos-tic significance of HALP (hemoglobin, albumin, lymphocyte, and platelet) in patients with bladder cancer after radical cystec-tomy. Sci Rep 2018;8(1):794.
7. 7. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative he-moglobin, albumin, lymphocyte, and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget 2015; 6 (38):41370–41382.
8. 8. Tian M, Li Y, Wang X, Tian X, Pei LL, Wang X, et al. The hemo-globin, albumin, lymphocyte, and platelet (HALP) score is asso-ciated with poor outcome of acute ischemic stroke. Front Neu-rol 2021;11:1-7.

9. 9. Karakayali M, Omar T, Artac I, Ilis D, Arslan A, Altunova M, et al. The prognostic value of HALP score in predicting in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis. 2023:1;34(7):483-8.
10. 10. Kiliç R, Güzel T, Aktan A, Güzel H, Kaya AF, Çankaya Y. The effec-tiveness of HALP score in predicting mortality in non-ST-elevation myocardial infarction patients. Coron Artery Dis. 2025;36(1):39-44.
11. 11. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983;51(3):606.
12. 12. Ouellette ML, Loffler AI, Beller GA, Workman VK, Holland E, Bourque JM. Clinical Characteristics, Sex Differences, and Out-comes in Patients With Normal or Near-Normal Coronary Arter-ies, Non-Obstructive or Obstructive Coronary Artery Disease. J Am Heart Assoc 2018;7: e007965.
13. 13. Sabanoglu C, Inanc IH. C-reactive protein to albumin ratio predicts for severity of coronary artery disease and ischemia. Eur Rev Med Pharmacol Sci. 2022;26(20):7623-7631.
14. 14. Özmen M. The role of C-reactive protein:albumin ratio and Neutrophil:lymphocyte ratio in predicting coronary artery dis-ease. Cardiovasc J Afr. Published online March 26, 2024.
15. 15. 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 Immunophar-macol 2023;114:109496.
16. 16. Tunca Ç, Taş A, Demirtaş İnci S. The role of the HALP score in determining the severity of lower extremity peripheral arterial disease. Vascular. 2025 Mar 27:17085381251330370.
17. 17. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-95.
18. 18. Barlas RS, Honney K, Loke YK, McCall SJ, Bettencourt-Silva JH, Clark AB, et al. Impact of hemoglobin levels and anemia on mortality in acute stroke: analysis of UK Regional Registry Data, systematic review, and metaanalysis. J Am Heart Assoc 2016;5(8):e003019.
19. 19. Alexandru N, Andrei E, Dragan E, Georgescu A. Interaction of platelets with endothelial progenitor cells in the experimental atherosclerosis: Role of transplanted endothelial progenitor cells and platelet microparticles. Biol Cell 2015;107 (6):189–204.
20. 20. Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, 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.
21. 21. Plakht Y, Gilutz H, Shiyovich A. Decreased admission serum albumin level is an independent predictor of long-term mortal-ity in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20–24.