Vol 7, No 4 (2022)
Research paper
Published online: 2022-10-20

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Investigation of the relationship between HALP score and mortality in patients with acute ischemic stroke

Erdem Kurt1, Sebnem Zeynep Eke Kurt2
Disaster Emerg Med J 2022;7(4):203-208.


INTRODUCTION: Acute ischemic stroke (AIS) is the leading cause of death and long-term disability world­wide. The aim of this study is to examine the relationship between HALP (hemoglobin, albumin, platelet, lymphocyte) score and mortality in patients diagnosed with AIS who visited the emergency department (ED).

MATERIAL AND METHODS: Data of AIS patients aged 18 years and older who visited ED during the study period were analyzed retrospectively. Data were obtained from an electronic-based hospital information system. The area under the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate each discriminant cut-off value to estimate mortality.

RESULTS: A total of 138 patients were included in this study, the median age of the patients was 66, and 74 (54%) were male. While the average hospital stay of the patients was 5 days, 30 patients were admit­ted to the intensive care units. As a result of the ROC analysis of the HALP score to predict the presence of in-hospital mortality, the area under the curve was calculated as 0.701 (95% CI: 0.553–0.849), the Youden index was 0.334, and the p-value was 0.001. When the cut-off value of the HALP score in determining the presence of in-hospital mortality is > 29.44, the sensitivity is 58.4%, the specificity is 75.0%, the positive predictive value is 96.05%, and the negative predictive value is 14.75%.

CONCLUSIONS: In our study, we concluded that the HALP score can be a good predictor of mortality in stroke patients. We recommend the use of the score because it is cheap, practical, and useful.

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  1. The world health organization monica project (monitoring trends and determinants in cardiovascular disease): A major international collaboration. Journal of Clinical Epidemiology. 1988; 41(2): 105–114.
  2. Weinberger J. Stroke. 2nd. ed. Handbooks in Health Care Co, Pennsylvania 2002: 1–80.
  3. Ferris A, Robertson RM, Fabunmi R, et al. American Heart Association, American Stroke Association. American Heart Association and American Stroke Association national survey of stroke risk awareness among women. Circulation. 2005; 111(10): 1321–1326.
  4. Sakal C, Ak R, Taşçı A, et al. Admission blood lactate levels of patients diagnosed with cerebrovascular disease effects on short- and long-term mortality risk. Int J Clin Pract. 2021; 75(8): e14161.
  5. Peng D, Zhang CJ, Tang Qi, et al. Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy. BMC Urol. 2018; 18(1): 20.
  6. Yang N, Han X, Yu J, et al. Hemoglobin, albumin, lymphocyte, and platelet score and neutrophil-to-lymphocyte ratio are novel significant prognostic factors for patients with small-cell lung cancer undergoing chemotherapy. J Cancer Res Ther. 2020; 16(5): 1134–1139.
  7. Shen XB, Zhang YX, Wang W, et al. 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.
  8. 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.
  9. Jiang H, Li H, Li A, et al. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget. 2016; 7(44): 72076–72083.
  10. Peng D, Zhang CJ, Gong YQ, et al. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy. Sci Rep. 2018; 8(1): 794.
  11. Seiffge DJ, Werring DJ, Paciaroni M, et al. Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation. Lancet Neurol. 2019; 18(1): 117–126.
  12. Milionis H, Papavasileiou V, Eskandari A, et al. Anemia on admission predicts short- and long-term outcomes in patients with acute ischemic stroke. Int J Stroke. 2015; 10(2): 224–230.
  13. Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015; 52(4): 261–269.
  14. Ferrucci L, Guralnik JM, Woodman RC, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med. 2005; 118(11): 1288.
  15. Sarnak MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol. 2002; 40(1): 27–33.
  16. Tanne D, Molshatzki N, Merzeliak O, et al. Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study. BMC Neurol. 2010; 10: 22.
  17. He P, Curry FE. Albumin modulation of capillary permeability: role of endothelial cell [Ca2+]i. Am J Physiol. 1993; 265(1 Pt 2): H74–H82.
  18. Babu MS, Kaul S, Dadheech S, et al. Serum albumin levels in ischemic stroke and its subtypes: correlation with clinical outcome. Nutrition. 2013; 29(6): 872–875.
  19. Belayev L, Pinard E, Nallet H, et al. Albumin therapy of transient focal cerebral ischemia: in vivo analysis of dynamic microvascular responses. Stroke. 2002; 33(4): 1077–1084.
  20. Dávalos A, Ricart W, Gonzalez-Huix F, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996; 27(6): 1028–1032.
  21. Usage of the Ranson criteria and neutrophil-lymphocyte ratio measured on presentation to the emergency department in the prediction of mortality in acute pancreatitis. Signa Vitae. 2022.
  22. Stubbe T, Ebner F, Richter D, et al. Regulatory T cells accumulate and proliferate in the ischemic hemisphere for up to 30 days after MCAO. J Cereb Blood Flow Metab. 2013; 33(1): 37–47.
  23. Ooboshi H, Ibayashi S, Shichita T, et al. Postischemic gene transfer of interleukin-10 protects against both focal and global brain ischemia. Circulation. 2005; 111(7): 913–919.
  24. Alexandru N, Andrei E, Dragan E, et al. 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.
  25. Yang M, Pan Y, Li Z, et al. Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II. Front Neurol. 2019; 10: 370.

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