Hemoglobin-Albumin-Lymphocyte-Platelet Index and Risk of In-Hospital Mortality in 793 Adult Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory condition of the airways, recognized as a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPD) significantly worsen clinical outcomes and often result in hospitalization, which is linked to increased mortality and a substantial socioeconomic burden. This study aimed to evaluate the role of the hemoglobin-albumin-lymphocyte-platelet (HALP) index in predicting the risk of in-hospital mortality in adult patients hospitalized for AECOPD. MATERIAL AND METHODS A total of 793 patients (mean±SD age: 71.5±10.2 years, range 23.8-98.4 years, 69.1% males) hospitalized with AECOPD were included in this retrospective cohort study. Data on patient demographics, comorbidities, laboratory findings on the day of hospital admission, intensive care unit (ICU) stay (on initial admission or over the course of hospitalization), and in-hospital mortality rates were recorded. The factors predicting in-hospital mortality risk were analyzed via multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the performance of HALP score in identifying patients at risk of in-hospital mortality. RESULTS Multivariate logistic regression analysis revealed a significant association of lower HALP scores (OR 0.758, 95% CI: 0.586 to 0.980, P=0.034) with increased risk of in-hospital mortality. ROC curve analysis revealed the HALP score to identify patients at risk of in-hospital mortality at a cut-off value of <16.84 (area under curve [AUC]: 0.678, 95% CI: 0.615-0.742, P<0.001) with a sensitivity of 69.1%, specificity of 60.4%, and a NPV of 96.3%. CONCLUSIONS Our findings indicate that the HALP score (at a cut-off value of <16.84) can identify AECOPD patients at high risk of in-hospital mortality, emphasizing its potential use as a simple immune-nutritional prognostic biomarker in assisting accurate prognostic assessment and timely adjustment of treatment options in at-risk patients.

Figure 1

ROC analysis for the performance of HALP score in discriminating patients at risk of mortality in the setting of AECOPD-related hospitalization. AUC – area under curve; PPV – positive predictive value; NPV – negative predictive value.