Associations of HALP score with serum prostate-specific antigen and mortality in middle-aged and elderly individuals without prostate cancer

Abstract

Background: The association between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and serum prostate-specific antigen (PSA) and all-cause mortality remains underexplored. We aimed to investigate the relationship between HALP score and these outcomes among middle-aged and elderly individuals without prostate cancer (PCa).

Methods: This cross-sectional study included participants aged 40 years and older from National Health and Nutrition Examination Survey (NHANES) 2001-2010. HALP score was calculated using the formula: HALP score = (Hemoglobin × Albumin × Lymphocytes)/Platelets. High PSA level was defined as a percentage free PSA (%fPSA) less than or equal to 25% and a total PSA (tPSA) level equal to or higher than 4.0 ng/mL. Mortality data were obtained through December 30, 2019 by linking to the National Death Index.

Results: Among 7,334 participants, 6,826 were classified as having low PSA level, while 508 were categorized as having high PSA level. Logistic regression revealed lower odds of high PSA level with higher HALP quartiles (P _trend<0.001). Among 508 participants with high PSA level, over a median follow-up period of 10.13 years (IQR: 5.42-13.17 years), a total of 268 all-cause deaths were recorded. Cox regression analysis showed that participants in the highest HALP quartile had the lowest risk of all-cause mortality (HR = 0.527, 95% CI: 0.368-0.754) in participants with high PSA level. Restricted cubic spline analysis indicated a non-linear and negative correlation between HALP score and all-cause mortality, with an inflection point at 43.98 (P for non-linearity = 0.009). Random survival forest analysis ranked HALP score as the most significant predictor for all-cause mortality.

Conclusion: Our study highlights that the HALP score the HALP score is associated with high PSA level and all-cause mortality among middle-aged and elderly individuals without PCa. Further research is warranted to validate these findings and elucidate underlying mechanisms.

Keywords: HALP score; NHANES; PSA; mortality; prostate cancer.

Figure 1

Kaplan-Meier survival curves for high PSA level, and HALP score, and all-cause mortality. (A) high PSA level and all-cause mortality in participants with men 40 years and older; (B) HALP score and all-cause mortality in participants with high PSA level.

Figure 2

Restricted cubic spline (RCS) analysis with multivariate-adjusted associations of HALP score with all-cause mortality among participants with high PSA level in NHANES 2001–2010. Models are adjusted for age (40-59, or ≥60 years), race/ethnicity (non-Hispanic White, non-Hispanic Black or other race), living status (with partners, or alone), education level (below high school, high school, or above high school), family PIR (<1.0, or ≥1.0), BMI (<25.0, 25.0-29.9, or >29.9 kg/m2), drinking status (nondrinker, low-to-moderate drinker, or heavy drinker), smoking status (never smoker, former smoker, or current smoker), physical activity (inactive, insufficiently active, or active), HEI (in quartiles), and CCI (continuous).

Figure 3

Capability of HALP score and its components to predict mortality. (A) Time-dependent ROC curves were used to assess the predictive capability of HALP score for 3-, 5-, 10-, and 15-year all-cause mortality in participants with high PSA level; (B) Spearman's correlation analysis was used to calculate the correlation coefficients among HALP score and its components; (C) Ranking the significance of the HALP score and its components in predicting all-cause mortality using random survival forest analysis.