Hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict prognosis in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention

The combination of hemoglobin, albumin, lymphocytes, and platelets (HALP) is a comprehensive index of nutrition and systemic inflammation. This study aimed to assess the association between HALP score and major adverse cardiovascular events (MACEs) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). 2182 patients with AF and ACS or undergoing PCI were recruited and followed up for a median survival time of 1128 (807–1391) days. The endpoint was the incidence of MACEs including all-cause death, myocardial infarction, stroke, non-central nervous system embolism, and ischemia-driven revascularization. Kaplan-Meier curve was used to compare the MACEs risk in four groups divided by the HALP quartile. Cox analysis was performed to assess the relationships between HALP and MACE risk. Restricted cubic spline (RCS) was used to clarify the non-linear correlation of HALP with MACEs risk. The Kaplan-Meier curves showed statistically significant differences in outcomes among the four groups (log-rank P < 0.01). The results of Cox analysis demonstrated that compared with participants with low HALP scores, participants with the highest HALP score had a lower MACE risk adjusted HR: 0.61 (95% CI (0.45–0.81), P < 0.01. The RCS curve revealed that the HALP was non-linearly and L-shaped correlated with MACEs (P for overall = 0.02, P for nonlinear = 0.02). Two-stage Cox analysis showed that in patients with HALP scores < 44.95, for every 1-unit decrease in HALP, the risk of MACEs increased by 1.8%. Adding the HALP score into the GRACE model or CHA2DS2-VASc model significantly increased the original predictive value on MACEs or all-cause death. High HALP was associated with a reduced risk of MACEs risk in patients with AF and ACS or undergoing PCI. HALP may be a potential marker for independently predicting MACEs in patients with AF and ACS or undergoing PCI.