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Article

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

  • Authors:
    • Yong-Juan Lin
    • Ai-Bin Guo
    • Ming-Min Huang
    • Xue Liang
    • Yu Xie
    • Ling-Ling Li
  • View Affiliations / Copyright

    Affiliations: Department of Geriatric, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China, Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
  • Article Number: 24
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    Published online on: December 4, 2025
       https://doi.org/10.3892/br.2025.2097
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Abstract

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.
View Figures

Figure 1

Patient flowchart. END, early
neurological deterioration.

Figure 2

Correlation analysis of HALP score and
NIHSS score. Pearson correlation analysis evaluated the
relationship between HALP and NIHSS scores in patients with AIS
(n=431). (A) HALP scores exhibited a significant negative
correlation with NIHSS scores at admission. (B) HALP scores
exhibited a significant negative correlation with NIHSS scores at
Discharge. HALP score, hemoglobin, albumin, lymphocyte and platelet
score; NIHSS, national institute of health stroke scale.

Figure 3

Correlation analysis between HALP
score tertiles and outcome of patients with AIS. Patients with AIS
(n=431) were categorized into three groups: (Q1, n=142; Q2, n=144;
Q3, n=145) based on admission HALP score tertiles. Chi-square test
assessed the difference in END incidence, and heat map illustrated
the distribution of mRS scores among the tertiles. (A) Incidence of
END among groups of patients with AIS stratified by HALP score
tertiles. END incidence varied significantly across HALP tertiles
(Q1: 59.15%, Q2: 28.47%, Q3: 15.86%; χ²=158.87; P<0.001); (B)
Clinical outcome frequency across HALP score tertiles. The
distribution of mRS scores at 90 days differed significantly among
the groups (P<0.001), with the highest proportion of favorable
outcomes (mRS 0-1) in Q3 and the highest frequency of poor outcomes
(mRS 5-6) in Q1. HALP score, hemoglobin, albumin, lymphocyte and
platelet score; mRS, modified Rankin scale; AIS, acute ischemic
stroke; END, early neurological deterioration.
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Copy and paste a formatted citation
Spandidos Publications style
Lin Y, Guo A, Huang M, Liang X, Xie Y and Li L: Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction. Biomed Rep 24: 24, 2026.
APA
Lin, Y., Guo, A., Huang, M., Liang, X., Xie, Y., & Li, L. (2026). Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction. Biomedical Reports, 24, 24. https://doi.org/10.3892/br.2025.2097
MLA
Lin, Y., Guo, A., Huang, M., Liang, X., Xie, Y., Li, L."Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction". Biomedical Reports 24.2 (2026): 24.
Chicago
Lin, Y., Guo, A., Huang, M., Liang, X., Xie, Y., Li, L."Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction". Biomedical Reports 24, no. 2 (2026): 24. https://doi.org/10.3892/br.2025.2097
Copy and paste a formatted citation
x
Spandidos Publications style
Lin Y, Guo A, Huang M, Liang X, Xie Y and Li L: Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction. Biomed Rep 24: 24, 2026.
APA
Lin, Y., Guo, A., Huang, M., Liang, X., Xie, Y., & Li, L. (2026). Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction. Biomedical Reports, 24, 24. https://doi.org/10.3892/br.2025.2097
MLA
Lin, Y., Guo, A., Huang, M., Liang, X., Xie, Y., Li, L."Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction". Biomedical Reports 24.2 (2026): 24.
Chicago
Lin, Y., Guo, A., Huang, M., Liang, X., Xie, Y., Li, L."Clinical application of the HALP score for predicting early neurological deterioration in older patients with acute cerebral infarction". Biomedical Reports 24, no. 2 (2026): 24. https://doi.org/10.3892/br.2025.2097
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