Prognostic value of hemoglobin, albumin, lymphocyte, platelet (HALP) scores in patients with non-valvular atrial fibrillation: insights from the AFTER-2 study

OBJECTIVES: The relationship between hemoglobin, albumin, lymphocyte, platelet (HALP) score, and various cancers and cardiovascular diseases has been tested previously. However, the relationship between HALP score and non-valvular atrial fibrillation (NVAF) has not been adequately tested. Therefore, our study aimed to investigate the relationship between HALP score and mortality in patients with NVAF. METHODS: This study included 2,592 NVAF patients from 35 centers in Turkey. Patients were divided into two groups: those with HALP scores ≤ 58.96 (low HALP score group, 1,296 patients) and > 58.96 (high HALP score group, 1,296 patients). The primary outcome measured was all-cause mortality. RESULTS: The mean HALP score was 66 ± 33. Patients in the low HALP score group had higher 1- and 5-year all-cause mortality rates (1-year: 12.9% vs. 5.4%, p < 0.001; 5-year: 38.5% vs. 20.2%, p < 0.001). Cox regression analysis identified the HALP score as an independent predictor of mortality (1-year: HR = 0.987, 95% CI = 0.981-0.992, p < 0.001; 5-year: HR = 0.990, 95% CI = 0.987-0.993, p < 0.001). ROC analysis determined a HALP score 52.3 predicted 1-year mortality with 62.9% sensitivity and 62% specificity (AUC = 0.680); a score of 55 predicted 5-year mortality with 60.3% sensitivity and 62.2% specificity (AUC = 0.657). Kaplan-Meier analysis revealed increasing mortality over time in the low HALP score group (log-rank tests, 1-year = 44.86, p < 0.001; 5-year = 108.54, p < 0.001). CONCLUSIONS: The HALP score is a simple, accessible measure, and our findings suggest that lower HALP scores are associated with increased 1-year and 5-year mortality in NVAF patients. This provides a reference for clinicians assessing risk in this vulnerable population.