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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

No financial support was received from any institution or person.

Etik Beyan

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).

Kaynakça

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