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Predictive value of the hemoglobin–albumin–lymphocyte–platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

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Abstract

The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) is a novel indicator reflecting systemic inflammation and nutritional status. To explore the relationship between HALP score and ICU mortality risk in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). A total of 1533 AECOPD patients from the eICU Collaborative Research Database (eICU-CRD) between 2014 and 2015 were included in this retrospective cohort study. Univariate and multivariate Cox proportional hazards models were utilized to investigate the association of HALP score, platelet-to-lymphocyte ratio (PLR) score, and lymphocyte-to-monocyte ratio (LMR) score with the ICU mortality risk in patients with AECOPD. Stratified analyses were performed based on patients’ ICU admission type, body mass index (BMI), and Acute Physiology, Age and Chronic Health Evaluation IV (APACHE IV) score. Of these 1533 AECOPD patients, 123 (8.00%) patients died in the ICU. Low HALP score [hazard ratio (HR) = 1.69; 95% confidence interval (CI) 1.14–2.53] and low LMR score (HR = 1.60; 95% CI 1.07–2.39) were associated with an increased ICU mortality risk in patients with AECOPD after adjusting for all confounders. Stratified analyses indicated that low HALP score were still associated with a higher ICU mortality risk in patients admitted to ICU by emergency (HR = 1.81; 95% CI 1.11–2.96), obese patients (HR = 2.81; 95% CI 1.29–6.10), and patients with low APACHE scores (HR = 2.87; 95% CI 1.75–4.69). Low HALP score was associated with an increased risk of ICU mortality in patients with AECOPD, suggesting that the HALP score may be a novel prognostic predictor in patients with AECOPD.

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References

  1. Celli BR, Wedzicha JA (2019) Update on clinical aspects of chronic obstructive pulmonary disease. New Engl J Med 381(13):1257–1266. https://doi.org/10.1056/NEJMra1900500

    Article  CAS  Google Scholar 

  2. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N et al (2018) Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global burden of disease study 2017. Lancet (London, England) 392(10159):1736–1788. https://doi.org/10.1016/s0140-6736(18)32203-7

    Article  Google Scholar 

  3. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A (2017) Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report GOLD executive summary. Am J Respir Crit Care Med 195(5):557–582. https://doi.org/10.1164/rccm.201701-0218PP

    Article  CAS  Google Scholar 

  4. MacLeod M, Papi A, Contoli M, Beghé B, Celli BR, Wedzicha JA, Fabbri LM (2021) Chronic obstructive pulmonary disease exacerbation fundamentals: diagnosis, treatment, prevention and disease impact. Respirology (Carlton, Vic) 26(6):532–551. https://doi.org/10.1111/resp.14041

    Article  Google Scholar 

  5. Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, Negri S, Carru C, Zinellu A (2018) Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. Eur Respir Rev 27(147):170113. https://doi.org/10.1183/16000617.0113-2017

    Article  Google Scholar 

  6. Kandemir Y, Doğan N, Yaka E, Pekdemir M, Yılmaz S (2021) Clinical characteristics of neutrophilic, eosinophilic and mixed-type exacerbation phenotypes of COPD. Am J Emerg Med 45:237–241. https://doi.org/10.1016/j.ajem.2020.08.044

    Article  Google Scholar 

  7. Semenzato U, Biondini D, Bazzan E, Tiné M, Balestro E, Buldini B, Carizzo SJ, Cubero P, Marin-Oto M, Casara A, Baraldo S, Turato G, Gregori D, Marin JM, Cosio MG, Saetta M (2021) Low-blood lymphocyte number and lymphocyte decline as key factors in COPD outcomes: a longitudinal cohort study. Respir Int Rev Thorac Dis 100(7):618–630. https://doi.org/10.1159/000515180

    Article  Google Scholar 

  8. Yao C, Liu X, Tang Z (2017) Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD. Int J Chron Obstruct Pulmon Dis 12:2285–2290. https://doi.org/10.2147/copd.S141760

    Article  Google Scholar 

  9. Kumar P, Law S, Sriram KB (2017) Evaluation of platelet lymphocyte ratio and 90-day mortality in patients with acute exacerbation of chronic obstructive pulmonary disease. J Thorac Dis 9(6):1509–1516. https://doi.org/10.21037/jtd.2017.05.77

    Article  Google Scholar 

  10. Baldemir R, Cirik M (2022) Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease: prognostic nutritional index, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratio. Medicine 101(24):e29433. https://doi.org/10.1097/md.0000000000029433

    Article  CAS  Google Scholar 

  11. Raad S, Smith C, Allen K (2019) Nutrition status and chronic obstructive pulmonary disease: can we move beyond the body mass index? Nutr Clin Prac 34(3):330–339. https://doi.org/10.1002/ncp.10306

    Article  Google Scholar 

  12. Girón R, Matesanz C, García-Río F, de Santiago E, Mancha A, Rodríguez-Salvanés F, Ancochea J (2009) Nutritional state during COPD exacerbation: clinical and prognostic implications. Ann Nutr Metab 54(1):52–58. https://doi.org/10.1159/000205960

    Article  CAS  Google Scholar 

  13. Yang IA, Brown JL, George J, Jenkins S, McDonald CF, McDonald VM, Phillips K, Smith BJ, Zwar NA, Dabscheck E (2017) COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. Med J Aust 207(10):436–442. https://doi.org/10.5694/mja17.00686

    Article  Google Scholar 

  14. Mekal D, Czerw A, Deptala A (2021) Dietary behaviour and nutrition in patients with COPD treated with long-term oxygen therapy. Int J Environ Res Public Health 18(23):12739. https://doi.org/10.3390/ijerph182312793

    Article  CAS  Google Scholar 

  15. Cong L, Hu L (2017) The value of the combination of hemoglobin, albumin, lymphocyte and platelet in predicting platinum-based chemoradiotherapy response in male patients with esophageal squamous cell carcinoma. Int Immunopharmacol 46:75–79. https://doi.org/10.1016/j.intimp.2017.02.027

    Article  CAS  Google Scholar 

  16. Guo Y, Shi D, Zhang J, Mao S, Wang L, Zhang W, Zhang Z, Jin L, Yang B, Ye L, Yao X (2019) The Hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel significant prognostic factor for patients with metastatic prostate cancer undergoing cytoreductive radical prostatectomy. J Cancer 10(1):81–91. https://doi.org/10.7150/jca.27210

    Article  CAS  Google Scholar 

  17. Tian M, Li Y, Wang X, Tian X, Pei LL, Wang X, Zhang L, Sun W, Wu J, Sun S, Ning M, Buonanno F, Xu Y, Song B (2020) The Hemoglobin, albumin, lymphocyte, and platelet (HALP) score is associated with poor outcome of acute ischemic stroke. Front Neurol 11:610318. https://doi.org/10.3389/fneur.2020.610318

    Article  Google Scholar 

  18. Xu SS, Li S, Xu HX, Li H, Wu CT, Wang WQ, Gao HL, Jiang W, Zhang WH, Li TJ, Ni QX, Liu L, Yu XJ (2020) Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol 26(8):828–838. https://doi.org/10.3748/wjg.v26.i8.828

    Article  CAS  Google Scholar 

  19. Pollard TJ, Johnson AEW, Raffa JD, Celi LA, Mark RG, Badawi O (2018) The eICU collaborative research database, a freely available multi-center database for critical care research. Sci Data 5:180178. https://doi.org/10.1038/sdata.2018.178

    Article  Google Scholar 

  20. Leetanaporn K, Hanprasertpong J (2022) Predictive value of the hemoglobin-albumin-lymphocyte-platelet (HALP) index on the oncological outcomes of locally advanced cervical cancer patients. Cancer Manag Res 14:1961–1972. https://doi.org/10.2147/cmar.S365612

    Article  Google Scholar 

  21. Rowe BH, Bhutani M, Stickland MK, Cydulka R (2011) Assessment and management of chronic obstructive pulmonary disease in the emergency department and beyond. Expert Rev Respir Med 5(4):549–559. https://doi.org/10.1586/ers.11.43

    Article  Google Scholar 

  22. Spelta F, Fratta Pasini AM, Cazzoletti L, Ferrari M (2018) Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord 23(1):15–22. https://doi.org/10.1007/s40519-017-0456-z

    Article  Google Scholar 

  23. Shi L, Zhu B, Xu M, Wang X (2018) Selection of AECOPD-specific immunomodulatory biomarkers by integrating genomics and proteomics with clinical informatics. Cell Biol Toxicol 34(2):109–123. https://doi.org/10.1007/s10565-017-9405-x

    Article  CAS  Google Scholar 

  24. Park SC, Kim YS, Kang YA, Park EC, Shin CS, Kim DW, Rhee CK (2018) Hemoglobin and mortality in patients with COPD: a nationwide population-based cohort study. Int J Chron Obstr Pulm Dis 13:1599–1605. https://doi.org/10.2147/copd.S159249

    Article  CAS  Google Scholar 

  25. Toft-Petersen AP, Torp-Pedersen C, Weinreich UM, Rasmussen BS (2016) Association between hemoglobin and prognosis in patients admitted to hospital for COPD. Int J Chron Obstr Pulm Dis 11:2813–2820. https://doi.org/10.2147/copd.S116269

    Article  CAS  Google Scholar 

  26. Chen D, Jiang L, Li J, Tan Y, Ma M, Cao C, Zhao J, Wan X (2021) Interaction of acute respiratory failure and acute kidney injury on in-hospital mortality of patients with acute exacerbation COPD. Int J Chron Obstr Pulm Dis 16:3309–3316. https://doi.org/10.2147/copd.S334219

    Article  Google Scholar 

  27. El-Gazzar AG, Kamel MH, Elbahnasy OKM, El-Naggar ME (2020) Prognostic value of platelet and neutrophil to lymphocyte ratio in COPD patients. Expert Rev Respir Med 14(1):111–116. https://doi.org/10.1080/17476348.2019.1675517

    Article  CAS  Google Scholar 

  28. Bhindi B, Hermanns T, Wei Y, Yu J, Richard PO, Wettstein MS, Templeton A, Li K, Sridhar SS, Jewett MA, Fleshner NE, Zlotta AR, Kulkarni GS (2016) Identification of the best complete blood count-based predictors for bladder cancer outcomes in patients undergoing radical cystectomy. Br J Cancer 114(2):207–212. https://doi.org/10.1038/bjc.2015.432

    Article  CAS  Google Scholar 

  29. Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, Neeser O, Huber A, Stanga Z, Mueller B, Schuetz P (2020) Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study. Am J Med 133(6):713-722.e717. https://doi.org/10.1016/j.amjmed.2019.10.031

    Article  CAS  Google Scholar 

  30. Zinellu A, Paliogiannis P, Sotgiu E, Mellino S, Fois AG, Carru C, Mangoni AA (2021) Platelet count and platelet indices in patients with stable and acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. COPD 18(2):231–245. https://doi.org/10.1080/15412555.2021.1898578

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of General Practice, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China

    Huishan Han & Siying Hu

  2. Department of Respiratory, Guang’an People’s Hospital, No.1 Mingkang Street, Guang’an District, Guang’an, 638000, China

    Juan Du

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Han, H., Hu, S. & Du, J. Predictive value of the hemoglobin–albumin–lymphocyte–platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Intern Emerg Med 18, 85–96 (2023). https://doi.org/10.1007/s11739-022-03132-4

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