Association of the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) Score with 3-Month Outcomes After Lumbar Medial Branch Radiofrequency Ablation: A Retrospective Cohort Study.

Background

The hemoglobin-albumin-lymphocyte-platelet (HALP) score integrates the immunonutritional and inflammatory status. We evaluated whether baseline HALP predicts the 3-month response after lumbar medial branch radiofrequency ablation (RFA), defined as a Visual Analogue Scale (VAS) reduction of ≥50% and an Oswestry Disability Index (ODI) reduction of ≥40%, and identified a Youden-optimal cut-off. The discrimination and calibration of multivariable models were also assessed.

Methods

This single-center retrospective cohort (N = 120) included rigorously selected patients (≥50% pain relief after two comparative medial branch blocks) undergoing standardized RFA. Multivariable logistic regression was adjusted for age, sex, Body Mass Index (BMI), smoking status, paraspinal tenderness, and baseline scores. We quantified the Area Under the Receiver Operating Characteristic Curve (AUC), Hosmer-Lemeshow (HL) goodness-of-fit, Brier score, and calibration slope; optimism was corrected using a 500-bootstrap method.

Results

Responses occurred in 64.2% (VAS) and 65.8% (ODI) of participants. HALP independently predicted ODI (OR = 1.06, 95% CI 1.02-1.09; p < 0.001) and VAS (OR = 1.05, 95% CI 1.02-1.08; p = 0.001). As a single predictor, HALP showed fair discrimination (AUC 0.717 [VAS], 0.731 [ODI]). The Youden cut-off of 39.8 yielded high sensitivity (~0.87) with modest specificity (~0.58-0.61). Multivariable AUCs were 0.744 (VAS) and 0.774 (ODI), optimism-corrected to 0.680 and 0.720; calibration was acceptable (HL p > 0.05; slopes ≈ 0.74-0.78; Brier 0.188/0.179).

Conclusions

HALP is a simple, low-cost adjunct that independently predicts short-term pain and functional outcomes after lumbar medial branch RFA. Incorporation into post-block triage may refine selection, especially for functional improvement, pending prospective external validation and recalibration of the cut-off.