# Association of the Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) Score with 3-Month Outcomes After Lumbar Medial Branch Radiofrequency Ablation: A Retrospective Cohort Study

## TL;DR

A new score called HALP can predict how well patients will respond to a specific back pain treatment three months after the procedure.

## Contribution

The HALP score is shown to independently predict short-term outcomes after lumbar medial branch radiofrequency ablation.

## Key findings

- HALP independently predicted functional improvement (ODI) and pain reduction (VAS) after RFA.
- The optimal HALP cut-off of 39.8 showed high sensitivity but modest specificity for predicting outcomes.
- Multivariable models had acceptable calibration and moderate discrimination for predicting outcomes.

## Abstract

Background: The hemoglobin–albumin–lymphocyte–platelet (HALP) score integrates the immunonutritional and inflammatory status. We evaluated whether baseline HALP predicts the 3-month response after lumbar medial branch radiofrequency ablation (RFA), defined as a Visual Analogue Scale (VAS) reduction of ≥50% and an Oswestry Disability Index (ODI) reduction of ≥40%, and identified a Youden-optimal cut-off. The discrimination and calibration of multivariable models were also assessed. Methods: This single-center retrospective cohort (N = 120) included rigorously selected patients (≥50% pain relief after two comparative medial branch blocks) undergoing standardized RFA. Multivariable logistic regression was adjusted for age, sex, Body Mass Index (BMI), smoking status, paraspinal tenderness, and baseline scores. We quantified the Area Under the Receiver Operating Characteristic Curve (AUC), Hosmer–Lemeshow (HL) goodness-of-fit, Brier score, and calibration slope; optimism was corrected using a 500-bootstrap method. Results: Responses occurred in 64.2% (VAS) and 65.8% (ODI) of participants. HALP independently predicted ODI (OR = 1.06, 95% CI 1.02–1.09; p < 0.001) and VAS (OR = 1.05, 95% CI 1.02–1.08; p = 0.001). As a single predictor, HALP showed fair discrimination (AUC 0.717 [VAS], 0.731 [ODI]). The Youden cut-off of 39.8 yielded high sensitivity (~0.87) with modest specificity (~0.58–0.61). Multivariable AUCs were 0.744 (VAS) and 0.774 (ODI), optimism-corrected to 0.680 and 0.720; calibration was acceptable (HL p > 0.05; slopes ≈ 0.74–0.78; Brier 0.188/0.179). Conclusions: HALP is a simple, low-cost adjunct that independently predicts short-term pain and functional outcomes after lumbar medial branch RFA. Incorporation into post-block triage may refine selection, especially for functional improvement, pending prospective external validation and recalibration of the cut-off.