Predictive value of the hemoglobin, albumin, lymphocyte, and platelet score for mortality in asthma.

BACKGROUND

Inflammation and nutritional status are critical factors in the progression of bronchial asthma. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has emerged as a promising integrated marker for assessing inflammatory and nutritional status, yet its prognostic value in asthma remains unexplored.

OBJECTIVE

To explore the relationship between the HALP score and the prognosis of patients with asthma.

METHODS

We analyzed data from 1303 patients with asthma from the National Health and Nutrition Examination Survey (2005-2018) cohort. Survival associations were assessed using Kaplan-Meier curves, multivariable Cox regression, and restricted cubic splines. Predictive performance was evaluated by means of time-dependent receiver operating characteristic curves. An independent clinical dataset of hospitalized patients with asthma was used for external validation to ensure generalizability.

RESULTS

In the National Health and Nutrition Examination Survey cohort, the highest HALP tertile (quartile [Q]3) exhibited the highest cumulative survival. Multivariable Cox analysis revealed that the Q3 group had a 53.1% lower mortality risk than the Q1 group (hazard ratio [HR] = 0.469, 95% CI: 0.259-0.847). Restricted cubic splines analysis identified a nonlinear relationship with a threshold at 61.33; below this threshold, each 1-unit increase in HALP reduced the mortality risk by 3% (HR = 0.97). The model demonstrated strong predictive performance (area under the curves > 0.8 at 1, 3, 5, and 10 years). The external validation dataset confirmed these findings, showing a 65.7% risk reduction in the Q3 group (HR = 0.343, 95% CI: 0.155-0.761).

CONCLUSION

This study reveals a significant nonlinear association between the HALP score and all-cause mortality in adult patients with asthma. A low HALP score independently predicts poor prognosis, serving as a promising, readily available biomarker for identifying high-risk individuals.