Prognostic Implications of the Hemoglobin-Albumin-Lymphocyte-Platelet Index in Patients with Pemphigus.

INTRODUCTION

Pemphigus is a chronic autoimmune blistering disease with substantial morbidity and mortality. Although the hemoglobin-albumin-lymphocyte-platelet (HALP) index, a composite marker reflecting inflammatory and nutritional status, exhibits prognostic value in various immune-related diseases, its potential in pemphigus remains elusive. In this study, we investigated prognostic significance of the HALP index in 69 patients with pemphigus diagnosed between 2001 and 2024.

METHODS

We calculated the HALP index at diagnosis and stratified using maximally selected rank statistics, identifying a cutoff value of 45.9. Using Cox proportional hazards models, patients with low HALP index (≤45.9) had significantly poorer overall survival (OS) and lower remission rates than those with higher HALP.

RESULTS

Our multivariate analysis independently associated immunosuppressant use with improved OS (HR = 0.32; 95% CI: 0.13-0.79; p = 0.013), while a low HALP index was an independent predictor of mortality (HR = 2.84; 95% CI: 1.06-7.60; p = 0.038). Additionally, low HALP index was also independently associated with a longer time to remission (HR = 0.55; 95% CI: 0.31-0.97; p = 0.039).

CONCLUSION

The HALP index represents a simple and readily available biomarker that independently predicts survival and remission outcomes in patients with pemphigus, potentially helping risk stratification and personalized management in clinical practice.