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HALP Score as a Prognostic Biomarker in Tricuspid Valve Surgery: Association with in-Hospital and Long-Term Mortality
Yusuf Demir1, Betül Ayça Yamak2, Samet Sevinç3
1Department of Cardiology, Bakırçay University, Çiğli Training and Research Hospital, İzmir, Türkiye.
Purpose:
Tricuspid valve surgery is associated with significant perioperative and long-term risks. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score is an integrated biomarker reflecting nutritional, inflammatory, and hematologic status. HALP score has proven prognostic utility, yet its relevance in tricuspid valve surgery is not well established. This study aimed to evaluate the association between preoperative HALP score and both in-hospital and long-term mortality in patients undergoing tricuspid valve surgery.
Patients And Methods:
This retrospective study included adult patients (≥18 years) who underwent isolated or combined tricuspid valve surgery between 2014 and 2021. The HALP score was calculated as platelet count × hemoglobin × albumin / lymphocyte count. Patients were grouped into low and high HALP score categories based on the mean HALP score. Laboratory parameters, echocardiographic findings, and mortality rates were compared. Laboratory and echocardiographic data, as well as mortality outcomes, were compared. Logistic regression was used to identify independent predictors of in-hospital mortality, while Cox proportional hazards and Kaplan-Meier analyses assessed long-term mortality. ROC curve analysis was performed to determine the optimal HALP cutoff.
Results:
Among 277 patients, 28 (10.1%) experienced in-hospital mortality and 45 (16.1%) died during follow-up. Patients who died had significantly lower HALP scores (p < 0.001). Univariate analysis showed that age, atrial fibrillation, EuroSCORE, low hemoglobin, low albumin, lymphopenia, low HALP score, chronic kidney disease, and perioperative complications were associated with in-hospital mortality. However, only advanced CKD and perioperative complications remained significant in multivariate analysis. HALP score was independently associated with long-term mortality (p < 0.001). The optimal HALP cutoff was 0.2998 (sensitivity 73.3%, specificity 73.7%; AUC = 0.817).
Conclusion:
Lower preoperative HALP scores are associated with increased long-term mortality after tricuspid valve surgery. Although not predictive of in-hospital mortality, the HALP score may help identify high-risk patients using routine laboratory values.
