The Value of HALP Score in Predicting Adverse In-Hospital Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

TL;DR

The HALP score, based on blood markers, can predict hospital complications in patients undergoing heart valve replacement surgery.

Contribution

The study demonstrates that the HALP score is a novel, practical tool for predicting adverse outcomes in TAVR patients.

Findings

Lower HALP scores correlate with higher mortality, bleeding, and acute kidney injury in TAVR patients.

The HALP score shows strong discriminatory ability for adverse outcomes with high AUC values.

HALP remains independently associated with adverse outcomes after adjusting for confounding factors.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is widely used in patients with severe aortic stenosis. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is an easily obtainable composite index that reflects nutritional status and systemic inflammation. Methods: In this single-center retrospective study, 140 patients who underwent TAVR between 1 April 2021, and 31 October 2024, were included. Patients were stratified according to the median HALP score (32.65) into low (<32.65)- and high (≥32.65)-HALP groups. In-hospital outcomes were mortality, bleeding requiring transfusion of >5 units of red blood cells, acute kidney injury (AKI), need for mechanical ventilation >24 h, and length of hospital stay. Associations between the HALP score and clinical outcomes were evaluated using multivariable regression analyses, and the discriminatory performance of HALP was assessed using receiver operating characteristic (ROC) curves. Results: Patients with low HALP scores had higher rates of in-hospital mortality (11.4% vs. 4.2%; p = 0.002), bleeding (28.6% vs. 5.7%; p < 0.001), AKI (11.4% vs. 2.9%; p < 0.001), and need for mechanical ventilation >24 h (25.7% vs. 14.4%; p = 0.002), as well as longer hospital stay (4.82 ± 1.50 vs. 3.62 ± 1.94 days; p = 0.001) compared with the high-HALP group. In multivariable models, a lower HALP score remained independently associated with all adverse in-hospital outcomes. ROC analysis showed good discriminatory ability of the HALP score for mortality (area under the curve [AUC] = 0.816; cut-off = 20.16), bleeding (AUC = 0.798; cut-off = 24.94), AKI (AUC = 0.737; cut-off = 26.21), and need for mechanical ventilation (AUC = 0.735; cut-off = 27.36). Conclusions: The HALP score is independently associated with adverse in-hospital clinical outcomes in patients undergoing TAVR and may serve as a simple and practical tool for early risk stratification in this population.

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