Comparative Analysis of Novel Inflammatory and Nutritional Indices (m-HALP, HALP, SII, SIRI) for Risk Stratification...

Background: Reliable biomarkers integrating inflammatory and nutritional status are crucial for sepsis risk stratification. While indices like the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) are widely studied, the prognostic value of the modified Hemoglobin, Albumin, Lymphocyte, and Platelet (m-HALP) score in sepsis remains unclear. This study aimed to compare the prognostic accuracy of m-HALP, HALP, SII, and SIRI for 90-day mortality in patients diagnosed with sepsis in the emergency department. Materials and Methods: This single-center, retrospective observational study included 188 adult patients diagnosed with sepsis according to the Surviving Sepsis Campaign guidelines. Routine hemogram and biochemistry parameters obtained at admission were used to calculate SII, SIRI, HALP, and m-HALP scores. The primary endpoint was 90-day mortality, and secondary endpoints included 7-day mortality, ICU admission, and mechanical ventilation requirement. The discriminative performance of the indices was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: The median age of the cohort was 75.5 years, and the 90-day mortality rate was 49.5%. Among the evaluated indices, only the lower m-HALP scores demonstrated a statistically significant association with 90-day mortality in the overall cohort (AUC: 0.590, 95% CI: 0.509-0.671, p = 0.030). In the pneumosepsis subgroup, the prognostic performance of m-HALP was numerically higher (AUC: 0.667, 95% CI: 0.548-0.785, p = 0.006) with a sensitivity of 57.4% and specificity of 76.7% at a cut-off value of 522.11. Conversely, standard HALP, SII, and SIRI did not show statistically significant predictive value for 90-day mortality (p > 0.05). None of the indices successfully predicted 7-day mortality, ICU admission, or mechanical ventilation requirement. Conclusions: While m-HALP showed a statistically significant association with 90-day mortality, particularly in the pneumosepsis subgroup, its overall discriminative ability was poor-to-modest (overall AUC 0.590; pneumosepsis AUC 0.667). Consequently, m-HALP lacks sufficient accuracy for standalone clinical decision-making, rendering these findings strictly exploratory and hypothesis-generating. Future prospective, multicenter studies are needed to validate this independent association.