A novel prognostic tool for predicting mortality in palliative care patients: HALP score: HALP score and prediction of mortality

Fatih Eskin; Duygu Tutan

doi:10.5281/zenodo.7770456

Authors

Fatih Eskin Hitit University Faculty of Medicine Department of Internal Medicine, Çorum, Turkey https://orcid.org/0000-0002-3636-4004
Duygu Tutan Hitit University Erol Olçok Training and Research Hospital, Department of Internal Medicine, Çorum, Turkey https://orcid.org/0000-0003-0440-1146

DOI:

https://doi.org/10.5281/zenodo.7770456

Keywords:

HALP score, palliative care, prognostic tool

Abstract

Objective: Patients who have high mortality are treated in Palliative Care Units (PCU). The prognostic data to be obtained in the initial evaluation of these patients is important for planning the most appropriate clinical approach. The prognostic role of hemoglobin, albumin, lymphocyte, and platelet (HALP) score was investigated in the study.

Methods: A total of 1317 patients who received treatment in PCUs between January 2018 and December 2021 were included in this retrospective study. HALP scores of patients during admission to PCU were calculated. The patients were divided into two groups as discharge and mortality and HALP scores and other clinical characteristics of the two groups were compared. The relationship between HALP score and mortality was evaluated statistically.

Results: HALP score median of the mortality group (11.06) was lower than discharge group (21.36) (p<0.001). In the subgroup analysis made according to the presence of malignancy, it was found that the HALP score differed at significant levels between the discharge and mortality groups, regardless of malignancies (p<0.005). It was found in the regression analysis that the HALP score remained an independent predictor of mortality (p=0.005). In the receiver operating curve (ROC) Analysis, the optimal HALP score of patients was found to accurately predict mortality with a cut-off value of 20.51 with 77.7% sensitivity and 52.3% specificity (p<0.001). Having a HALP score of ≤20.51 during hospitalization was found to increase the probability of mortality 2.75 times.

Conclusion: The results show that the HALP score can be a new prognostic tool to provide an effective mortality prediction in palliative care patients. The HALP score, along with other clinical data, may contribute to a more accurate prognostic prediction.

References

United Nations Department of Economic Social Affairs. World Population Ageing 2020: Highlights; United Nations: 2021.

Morrison RS, Meier DE. Clinical practice. Palliative care. N Engl J Med. 2004; 350: 2582-90.

World Health Organization. Definition of Palliative Care. Available online: https://www.who.int/news-room/fact-sheets/detail/palliative-care (accessed on January 21st).

World Health Organization. Global Atlas of Palliative Care 2nd Edition. London: Worldwide Palliative Care Alliance; World Health Organization: 2020.

Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013; 368(13):1173-75.

Tuncer Ö, Bayındır A. Palyatif Bakım Hastalarında Malnütrisyon. Klinik Tıp Aile Hekimliği. 2017; 8(3):11-4.

Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008; 27(1):5-15.

Ruggeri E, Giannantonio M, Agostini F, Ostan R, Pironi L, Pannuti R. Home artificial nutrition in palliative care cancer patients: Impact on survival and performance status. Clin Nutr. 2020; 39(11):3346-53.

Lucijanic M, Veletic I, Rahelic D, Pejsa V, Cicic D, Skelin M, et al. Assessing serum albumin concentration, lymphocyte count and prognostic nutritional index might improve prognostication in patients with myelofibrosis. Wien Klin Wochenschr. 2018; 130(3-4):126-33.

Peng D, Zhang CJ, Gong YQ, Hao H, Guan B, Li XS, et al. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy. Sci Rep. 2018; 8(1):794.

Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015; 6(38):41370-82.

Cong L, Hu L. The value of the combination of hemoglobin, albumin, lymphocyte and platelet in predicting platinum-based chemoradiotherapy response in male patients with esophageal squamous cell carcinoma. Int Immunopharmacol. 2017; 46:75-9.

Jiang H, Li H, Li A, Tang E, Xu D, Chen Y, et al. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget. 2016; 7(44):72076-83.

Guo Y, Shi D, Zhang J, Mao S, Wang L, Zhang W, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score is a Novel Significant Prognostic Factor for Patients with Metastatic Prostate Cancer Undergoing Cytoreductive Radical Prostatectomy. J Cancer. 2019; 10(1):81-91.

Tian M, Li Y, Wang X, Tian X, Pei LL, Wang X, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Associated With Poor Outcome of Acute Ischemic Stroke. Front Neurol. 2021; 11:610318.

Barlas RS, Honney K, Loke YK, McCall SJ, Bettencourt-Silva JH, Clark AB, et al. Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta-Analysis. J Am Heart Assoc. 2016; 5(8):e003019.

Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, et al. Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study. Am J Med. 2020; 133(6):713-22.

Huang XZ, Yang YC, Chen Y, Wu CC, Lin RF, Wang ZN, et al. Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis. Dis Markers. 2019; 2019:7606128.

Wu N, Chen G, Hu H, Pang L, Chen Z. Low pretherapeutic serum albumin as a risk factor for poor outcome in esophageal squamous cell carcinomas. Nutr Cancer. 2015; 67(3):481-5.

Rho SY, Hwang HK, Chong JU, Yoon DS, Lee WJ, Kang CM. Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer. ANZ J Surg. 2019; 89(5):503-8.

Rachidi S, Li H, Wallace K, Li Z, Balch C, Lautenschlaeger T. Preoperative platelet counts and postoperative outcomes in cancer surgery: a multicenter, retrospective cohort study. Platelets. 2020; 31(1):79-87.

Liu X, Meng QH, Ye Y, Hildebrandt MA, Gu J, Wu X. Prognostic significance of pretreatment serum levels of albumin, LDH and total bilirubin in patients with non-metastatic breast cancer. Carcinogenesis. 2015; 36(2):243-8.

Vartolomei MD, Kimura S, Ferro M, Vartolomei L, Foerster B, Abufaraj M, et al. Is neutrophil-to-lymphocytes ratio a clinical relevant preoperative biomarker in upper tract urothelial carcinoma? A meta-analysis of 4385 patients. World J Urol. 2018; 36(7):1019-29.

Jan HC, Hu CY, Yang WH, Ou CH. Combination of Platelet-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio as a New Promising Prognostic Factor in Upper Tract Urothelial Carcinoma With Large Tumor Sizes > 3 cm. Clin Genitourin Cancer. 2020; 18(4):e484-500.

Peng D, Zhang CJ, Tang Q, Zhang L, Yang KW, Yu XT, et al. Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy. BMC Urol. 2018; 18(1):20.

Han H, Hu S, Du J. Predictive value of the hemoglobin-albumin-lymphocyte-platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Intern Emerg Med. 2023; 18(1):85-96.

Akbas A, Koyuncu S, Hacım NA, Dasiran MF, Kasap ZA, Okan I. Can HALP (Hemoglobin, Albumin, Lymphocytes, and Platelets) Score Differentiate Between Malignant and Benign Causes of Acute Mechanic Intestinal Obstruction?. Cancer Biother Radiopharm. 2022; 37(3):199-204.

Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011; 10(4):430-9.

Albers G, Martins Pereira S, Onwuteaka-Philipsen B, Deliens L, Pasman R, Van den Block L. A public health perspective on palliative care for older people: an introduction. Palliative care for older people: a public health perspective. 2015. P. 3-16.

Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, et al. A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage. 1999; 17(4):231-9.

Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer. 1999; 7(3):128-33.

Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative performance scale (PPS): a new tool. J Palliat Care. 1996; 12(1):5-11.

Feliu J, Jiménez-Gordo AM, Madero R, Rodríguez-Aizcorbe JR, Espinosa E, Castro J, et al. Development and validation of a prognostic nomogram for terminally ill cancer patients. J Natl Cancer Inst. 2011; 103(21):1613-20.

Pantano Nde P, Paiva BS, Hui D, Paiva CE. Validation of the Modified Glasgow Prognostic Score in Advanced Cancer Patients Receiving Palliative Care. J Pain Symptom Manage. 2016; 51(2):270-7.

Pobar I, Job M, Holt T, Hargrave C, Hickey B. Prognostic tools for survival prediction in advanced cancer patients: A systematic review. J Med Imaging Radiat Oncol. 2021; 65(6):806-16.

Simmons CPL, McMillan DC, McWilliams K, Sande TA, Fearon KC, Tuck S, et al. Prognostic Tools in Patients With Advanced Cancer: A Systematic Review. J Pain Symptom Manage. 2017; 53(5):962-70.