HALP and FI-Lab Scores in Hospitalized Older Adults: A Retrospective Comparative Study of Adverse Outcomes

Early identification of poor prognosis in acutely hospitalized older adults is essential. Hemoglobin, albumin, lymphocyte, and platelet (HALP) scores have garnered attention as a predictor of poor prognosis in both cancer and non-cancer patients. The frailty index-laboratory (FI-lab) has also demonstrated utility as an indicator of unfavorable outcomes. Associations have been established between low HALP levels and high FI-lab scores with adverse outcomes. However, no study has yet compared these indicators to predict outcomes in hospitalized older adults.

This retrospective cohort study involved older adults admitted to a 730-bed tertiary hospital. The study encompassed patients aged 65 years or older admitted to the general internal medicine department and discharged between August 2020 and July 2023. The HALP score and FI-lab were computed based on laboratory parameters derived from blood tests conducted upon admission. The study assessed outcomes including in-hospital mortality, in-hospital falls, discharge to home, and length of hospital stay.

A total of 1346 patients, of whom 11.6% died during hospitalization. The FI-lab score was more predictive of in-hospital death than the HALP score. In Cox regression survival analysis, higher FI-lab scores (hazard ratio 1.70, 95% confidence interval 1.47-1.96, p < 0.01) and lower HALP scores (hazard ratio 1.62, 95% confidence interval 1.12-2.33, p < 0.01) were significantly associated with in-hospital mortality. Moreover, higher FI-lab scores and low HALP scores were linked to a prolonged hospital stay and reduced likelihood of discharge. In contrast, none of these indicators was correlated with in-hospital falls.

The FI-lab demonstrated superior predictive capability for in-hospital mortality compared to the HALP score. However, the HALP score also proved effective in forecasting adverse outcomes among older adults hospitalized in general internal medicine wards. Automatically calculable laboratory scores could offer significant value in caring for diverse older inpatients.