# Low HALP Score Predicts Prolonged Hospitalization in Solid Tumor Patients with Febrile Neutropenia

## TL;DR

A low HALP score is linked to longer hospital stays in cancer patients with febrile neutropenia, suggesting it could help doctors assess risk early.

## Contribution

This study identifies the HALP score as a novel, low-cost predictor of prolonged hospitalization in solid tumor patients with febrile neutropenia.

## Key findings

- Low HALP score, intermediate/high CISNE risk, and microbiological culture positivity independently predict prolonged hospitalization.
- HALP score showed a strong negative correlation with hospitalization duration (r = −0.469; p < 0.001).
- PNI lost significance after adjusting for other clinical factors, while CAR showed no meaningful association.

## Abstract

Febrile neutropenia (FN) is a serious complication of chemotherapy that often requires hospitalization. Identifying simple and accessible markers that can help predict clinical outcomes is important for improving patient management. In this retrospective study, we evaluated the relationship between the Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score, the C-reactive protein/albumin ratio (CAR), and the Prognostic Nutritional Index (PNI) with the length of hospital stay in 169 solid tumor patients hospitalized with FN. Our findings showed that a low HALP score, intermediate and high Clinical Index of Stable Febrile Neutropenia (CISNE) risk categories, and positive microbiological culture were independent predictors of prolonged hospitalization. In contrast, CAR showed no meaningful association, and PNI lost significance after adjustment for other clinical factors. These results suggest that HALP, together with clinical risk tools such as CISNE, may serve as a practical and low-cost marker to support early risk stratification in FN.

Background: Febrile neutropenia (FN) is a serious chemotherapy-related complication in patients with solid tumors. Identifying simple and accessible biomarkers that can predict prolonged hospitalization may support early risk stratification and clinical decision-making. Methods: This retrospective study included 169 adults hospitalized with FN between January 2023 and January 2025. Immunonutritional indices, including the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score, the Prognostic Nutritional Index (PNI), and the C-reactive protein/albumin ratio (CAR), as well as the Clinical Index of Stable Febrile Neutropenia (CISNE) score were calculated. HALP and PNI were categorized using ROC-derived cut-offs based on the Youden Index. Prolonged hospital stay was defined as a binary variable based on the cohort median (>9 days). Spearman correlation, univariate and multivariate logistic regression were performed to identify predictors of prolonged hospitalization. Results: HALP showed a significant negative correlation with hospitalization duration (r = −0.469; p < 0.001), as did serum albumin (r = −0.184; p = 0.017) and PNI (r = −0.273; p < 0.001). CAR (p = 0.617) and neutrophil count (p = 0.955) demonstrated no correlation. In univariate logistic regression, low HALP (p < 0.001), low PNI (p = 0.001), intermediate CISNE (p = 0.002), high CISNE (p < 0.001), microbiological culture positivity (p < 0.001), and sex (p = 0.015) were significantly associated with prolonged hospitalization. Age, comorbidity status, metastatic stage, and CAR were not significant. In the multivariate model, low HALP (p < 0.001), intermediate CISNE (p = 0.007), high CISNE (p < 0.001), and culture positivity (p < 0.001) remained independent predictors. PNI (p = 0.400) and sex (p = 0.176) did not retain significance. Conclusions: A Low HALP score, higher CISNE risk categories, and microbiological culture positivity independently predicted prolonged hospitalization in FN. HALP, as a simple and inexpensive immunonutritional marker, may enhance early FN risk assessment when used alongside validated clinical tools such as CISNE or MASCC.