The Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) Score as a useful predictor for mortality in older patients with hip fracture

Zhicong Wang ¹ Hailong Liu ² Mozhen Liu ^1*

• ¹ First Affiliated Hospital, Dalian Medical University, Dalian, China
• ² People’s Hospital of Deyang City, Deyang, Sichuan Province, China

Objective: With a rapidly aging population, identifying effective prognostic predictors has always been a research hotspot in older patients with hip fracture. Recently, the score combining hemoglobin, albumin, lymphocyte and platelet (HALP) has been proposed as a novel biomarker for reflecting systemic inflammation and nutritional status. However, it is unclear whether the HALP score could be a potential predictor of subsequent death after hip fracture. Therefore, this study aimed to determine the association between the HALP score and mortality in older patients with hip fracture, and further evaluate its predictive value.Methods: Consecutive patients between January 2013 and December 2022 were identified from our hip fracture database. Outcomes were all-cause death within 90 days of admission (90-day mortality) and at the longest follow-up (overall mortality). Multivariate Cox proportional hazard models and restricted cubic spline (RCS) were used to assess this association, and the c statistic, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate its incremental predictive performance.Results: A total of 1707 patients were included with a median follow-up of 44.4 months, of whom 174 cases (10.2%) died within 90 days and 667 cases (39.1%) died at the longest follow-up. After multivariate adjustment, compared to tertile 1 group, tertile 2 and tertile 3 group had 0.676-fold (95% confidence interval [CI]: 0.471-0.972, P = 0.035) and 0.598-fold (95% CI: 0.390-0.918, P = 0.019) lower risks of 90-day mortality, as well as 0.681-fold (95% CI: 0.566-0.820, P < 0.001) and 0.618-fold (95% CI: 0.504-0.759, P < 0.001) decreased risks of overall mortality, respectively. Consistently, each unit increase in the HALP score was associated with a 1.1% decrease in 90-day mortality, and a 1.0% decrease in overall mortality (all P < 0.05). RCS analyses indicated nonlinear relationships between the HALP score and 90-day and overall mortality (all P for nonlinear < 0.01). Moreover, adding the HALP score significantly improved the predictive ability for 90-day and overall mortality (all P < 0.05).The HALP score was independently associated with the risk of death, suggesting that the HALP score may be a useful predictor of mortality in older patients with hip fracture.