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Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) Score as a Novel Biomarker for Predicting Coronary Slow Flow in
Çağatay Tunca1, Reha Yasin Şengül1, Mehmet Taha Özkan1
1Department of Cardiology, Ankara Etlik City Hospital, Ministry of Health, Ankara 06170, Türkiye.
Insights
The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is lower in patients with coronary slow flow phenomenon (CSFP). This accessible index shows strong diagnostic performance for CSFP risk stratification.
Area of Science:
- Cardiology
- Immunonutrition
- Vascular Biology
Background:
- Coronary slow flow phenomenon (CSFP) is linked to inflammation, endothelial dysfunction, and microvascular issues in patients with angina or ischemia but non-obstructive coronary arteries (ANOCA/INOCA).
- The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel index that may capture this complex risk profile.
Purpose of the Study:
- To investigate the association between the HALP score and CSFP in patients with chronic coronary syndrome.
- To compare the diagnostic performance of the HALP score against other inflammatory markers for CSFP.
Main Methods:
- A retrospective case-control study involving 122 CSFP patients and 126 controls.
- Calculation of HALP score and inflammatory indices (NLR, PLR, SII, SIRI) from baseline laboratory values.
- Multivariable logistic regression, ROC analysis, and restricted cubic spline (RCS) modeling were used to evaluate associations.
Main Results:
- The HALP score was significantly lower in CSFP patients (56.2 vs. 65.9, p < 0.001).
- HALP was independently associated with CSFP (adjusted OR: 0.951; p < 0.001) and demonstrated the highest diagnostic performance (AUC: 0.698).
- A non-linear inverse relationship was observed between HALP score and CSFP risk.
Conclusions:
- The HALP score is independently associated with CSFP and outperforms traditional inflammatory markers.
- The HALP score is a promising, low-cost tool for risk stratification in ANOCA/INOCA patients.
- Further validation in multicenter prospective studies is warranted.
Abstract:
Background: The coronary slow flow phenomenon (CSFP) is an angiographic entity increasingly recognized in patients with angina and/or ischemia but non-obstructive coronary arteries (ANOCA/INOCA), associated with systemic inflammation, endothelial dysfunction, and microvascular abnormalities. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel immunonutritional index that may reflect this multifactorial risk profile. Methods: This retrospective single-center case-control study included 122 patients with CSFP and 126 age- and sex-matched controls with normal coronary flow, all presenting with symptoms of chronic coronary syndrome. CSFP was diagnosed via corrected TIMI frame count. HALP and other inflammatory indices (NLR, PLR, SII, SIRI) were calculated from baseline laboratory values. Associations were evaluated using multivariable logistic regression, ROC analysis, and restricted cubic spline (RCS) modeling. Results: The HALP score was significantly lower in CSFP patients (mean 56.2 vs. 65.9, p < 0.001). In multivariable analysis, HALP was independently associated with CSFP (adjusted OR: 0.951; 95% CI: 0.930-0.972; p < 0.001), whereas NLR lost significance. PLR, SII, and SIRI remained independently associated. HALP showed the highest diagnostic performance (AUC: 0.698), significantly outperforming all other indices (DeLong p < 0.001). A HALP cutoff ≤ 56.4 provided 58.2% sensitivity and 77.0% specificity. RCS analysis demonstrated a significant non-linear inverse relationship (p for non-linearity = 0.034). Subgroup analyses confirmed consistent associations across age, sex, hypertension, and diabetes strata. Conclusions: The HALP score is independently associated with CSFP and outperforms traditional inflammatory indices. Its low cost and accessibility make it a promising tool for clinical risk stratification in ANOCA/INOCA patients, pending validation in multicenter prospective studies.
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