Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction

The present study aimed to examine the relationship between the composite biomarker hemoglobin, albumin, lymphocyte and platelet (HALP) score and early neurological deterioration (END) to identify patients predisposed to poor neurological outcomes. A total of 148 older patients with acute ischemic stroke (AIS) who developed END and 283 without END were included. END was defined as an increase of at least two points in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days. Multivariate logistic regression was performed to assess predictors of the HALP score. Receiver Operating Characteristic (ROC) curves and calibration plots were employed to evaluate model performance. The results demonstrated that END occurred in 34.34% of participants. Univariate analysis demonstrated significant differences between the two groups in age, baseline NIHSS score, white blood cell count, lymphocyte count, HALP score, levels of hemoglobin, triglycerides, C‑reactive protein, homocysteine, lipoprotein phospholipase A2, and the incidence of infections and mortality (all P<0.05). In multivariate logistic regression, both the HALP score [odds ratio (OR): 0.965; 95% confidence interval (CI): 0.943‑0.988; P=0.003) and baseline NIHSS score (OR: 1.169; 95%CI: 1.119‑1.220; P<0.001) emerged as independent predictors of END. The areas under the ROC curve for a HALP score <27.69 and NIHSS score >5.5 were 0.727 (95% CI: 0.676‑0.778) and 0.868 (95% CI: 0.834‑0.903), respectively, with a combined AUC of 0.883 (95% CI: 0.850‑0.916). The HALP score demonstrated a significant negative correlation with baseline NIHSS (r=‑0.411, P<0.001) and NIHSS at day 7 (r=‑0.348, P<0.001). Patients with lower HALP scores exhibited higher rates of END and poorer 90‑day functional outcomes. In conclusion, reduced HALP scores were independently associated with END in older patients with AIS, suggesting that HALP may serve as an effective biomarker for the early identification of individuals at elevated risk of unfavorable neurological progression.