Prognostic value of the HALP score in patients undergoing emergency surgery for gastroduodenal perforation

Gastroduodenal perforation is a life-threatening surgical emergency associated with substantial postoperative morbidity and mortality. In the emergency setting, rapid and objective preoperative risk stratification remains challenging. This study aimed to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score for predicting postoperative outcomes in patients undergoing emergency surgery for gastroduodenal perforation.

This retrospective cohort study included 115 adults who underwent emergency surgery for gastroduodenal perforation at a tertiary referral center between January 2021 and December 2025. The HALP score was calculated using laboratory values obtained at admission before surgery. The primary endpoint was a composite adverse outcome defined as postoperative mortality, reoperation, or prolonged hospital stay (≥8 days). Clinical, laboratory, and operative variables were compared between patients with and without the composite outcome. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis.

Postoperative mortality occurred in five patients (4.3%). Non-survivors were older and had higher American Society of Anesthesiologists (ASA) classification than survivors (p<0.05). Patients who experienced the composite adverse outcome had significantly lower HALP and prognostic nutritional index (PNI) values and higher inflammatory indices on univariate analysis (p<0.05). In ROC analysis, the HALP score demonstrated modest discriminatory ability for predicting the composite adverse outcome (area under the curve [AUC] 0.619, 95% confidence interval [CI]: 0.511-0.719). Increasing age was associated with adverse outcomes, whereas a multivariable model incorporating age, ASA classification, and HALP score demonstrated improved discrimination (AUC 0.748).

The HALP score is an inexpensive and readily available preoperative marker that reflects both inflammatory and nutritional status. In this cohort, lower HALP values were associated with adverse postoperative outcomes on univariate analysis. Although HALP was not identified as an independent predictor in multivariable analysis, it may provide complementary information regarding patients' immunonutritional vulnerability when interpreted alongside established clinical risk factors. Further prospective multicenter studies are needed to validate its prognostic utility and establish clinically relevant cutoff values.