Key result
Low HALP score is linked to ~3.2-fold higher MACCE risk in rheumatic mitral stenosis.
Why the study?
Biomarkers reflecting systemic vulnerability may complement traditional hemodynamic risk assessment in rheumatic mitral stenosis, and the hemoglobin-albumin-lymphocyte-platelet (HALP) score has emerged as a potential prognostic marker integrating inflammatory and nutritional parameters.
Does a low hemoglobin–albumin–lymphocyte–platelet (HALP) score (<42.08) predict major adverse cardiac and cerebrovascular events (MACCE) in patients with rheumatic mitral stenosis?
Cohort (n=127)
Does a low hemoglobin–albumin–lymphocyte–platelet (HALP) score (<42.08) predict major adverse cardiac and cerebrovascular events (MACCE) in patients with rheumatic mitral stenosis?
In patients with rheumatic mitral stenosis, a low HALP score (<42.08) is independently associated with long-term MACCE, though it offers limited incremental predictive value over standard hemodynamic assessment.
Low HALP score was associated with higher MACCE risk in rheumatic mitral stenosis; leaves open incremental value for risk stratification.
Background Rheumatic mitral stenosis (RMS) is a chronic immune-mediated disease associated with substantial long-term morbidity and mortality. Biomarkers reflecting systemic vulnerability may complement traditional hemodynamic risk assessment. The hemoglobin–albumin–lymphocyte–platelet (HALP) score integrates inflammatory and nutritional parameters and has emerged as a potential prognostic marker in cardiovascular disease. Methods In this retrospective cohort study, 127 patients with RMS were followed for a median of 124 months. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE). Discrimination was assessed using receiver operating characteristic (ROC) analysis. Survival was evaluated by Kaplan–Meier analysis and Cox regression. Incremental value was examined using nested models with bootstrap validation, calibration metrics, net reclassification improvement (NRI), and decision curve analysis. Results During follow-up, 21 patients (16.5%) experienced MACCE. The HALP score demonstrated modest discrimination (AUC 0.644; 95% CI 0.509–0.773). A cutoff value of 42.08 identified patients with significantly lower MACCE-free survival (log-rank p = 0.015). In multivariable Cox analysis adjusted for age and atrial fibrillation, low HALP (<42.08) remained independently associated with MACCE (HR 3.16; 95% CI 1.00–9.95; p = 0.049). Although addition of HALP to a clinical–hemodynamic model produced small improvements in apparent discrimination, optimism-corrected performance and reclassification analyses suggested limited incremental predictive gain. Conclusions In RMS, a low HALP score is independently associated with long-term adverse outcomes. While its incremental discrimination beyond hemodynamic severity appears modest, HALP may serve as an accessible adjunct marker of systemic risk.Roc curve
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Ferhat et al. (2026) conducted a cohort in Rheumatic mitral stenosis (n=127). Low hemoglobin–albumin–lymphocyte–platelet (HALP) score (<42.08) vs. HALP score ≥42.08 was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (HR 3.16, 95% CI 1.00-9.95, p=0.049). Low HALP score (<42.08) was independently associated with major adverse cardiac and cerebrovascular events in rheumatic mitral stenosis (HR 3.16; 95% CI 1.00-9.95; p=0.049).
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