Prognostic significance of the HALP score in patients with acute ischemic stroke

To investigate the relationship between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and prognosis in patients with acute ischemic stroke (AIS).

This retrospective, cross-sectional, observational, single-center study enrolled 1128 patients with AIS who presented to the emergency department and were hospitalized between June 2019 and December 2021. The HALP score was calculated as follows: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Demographics, clinical characteristics, and HALP scores were compared between survivors and nonsurvivors to identify factors associated with in-hospital mortality.

The HALP scores for nonsurvivors and survivors were 13.9 [7.2-25.9] and 36.4 [22.8-52.8], respectively. Compared to the survivors, the HALP score was significantly lower in nonsurvivor patients.

The HALP score has prognostic value in patients with AIS. Patients with lower HALP scores at admission are at higher risk for prolonged hospital stay, need for intensive care, and mortality, suggesting that a low score may be predictive of poor prognosis in patients with AIS. The cut-off value for predicting mortality was 21.5. Key messages What is already known on this topic: Acute ischemic stroke (AIS) is a leading cause of death and disability worldwide, and accurate early prognostic markers are essential for guiding clinical decisions. Nutritional and inflammatory parameters such as hemoglobin, albumin, lymphocyte, and platelet counts have individually been associated with stroke prognosis. The HALP score-originally validated in cancer and critical illness-has recently emerged as a composite marker reflecting inflammation and nutritional status. However, data on its prognostic value in AIS patients remain limited and inconsistent. What this study adds: This study demonstrates that the HALP score on admission is an independent predictor of in-hospital mortality in AIS patients. A specific cut-off value of 21.5 was identified, below which the risk of death, intensive care unit (ICU) admission, and prolonged hospital stay significantly increased. The HALP score also showed good discriminative ability (Area under the curve (AUC)  = 0.781) in predicting adverse outcomes. How this study might affect research, practice or policy: The HALP score, calculated using routine and inexpensive laboratory parameters, may serve as a practical bedside tool for early risk stratification in AIS. Its use could help clinicians identify high-risk patients at triage and prioritize monitoring or interventions. Future prospective studies could support its integration into prognostic models or emergency care pathways for stroke.