Prognostic Value of Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) Scores in Patients with Non-Valvular Atrial Fibrillation: Insights From the AFTER-2 Study

Objectives: The relationship between hemoglobin, albumin, lymphocyte, platelet (HALP) score, and various cancers and cardiovascular diseases has been tested previously. However, the relationship between HALP score and non-valvular atrial fibrillation (NVAF) has not been adequately tested. Therefore, our study aimed to investigate the relationship between HALP score and mortality in patients with NVAF. Methods: This study included 2,592 NVAF patients from 35 centers in Turkey. Patients were divided into two groups: those with HALP scores ≤ 58.96 (low HALP score group, 1,296 patients) and > 58.96 (high HALP score group, 1,296 patients). The primary outcome measured was all-cause mortality. Results: The mean HALP score was 66±33. Patients in the low HALP score group had higher 1- and 5-year all-cause mortality rates (1-year: 12.9% vs. 5.4%, p<0.001; 5-year: 38.5% vs. 20.2%, p<0.001). Cox regression analysis identified the HALP score as an independent predictor of mortality (1-year: HR=0.987, 95% CI=0.981-0.992, p<0.001; 5-year: HR=0.990, 95% CI=0.987-0.993, p<0.001). ROC analysis determined a HALP score 52.3 predicted 1-year mortality with 62.9% sensitivity and 62% specificity (AUC=0.680); a score of 55 predicted 5-year mortality with 60.3% sensitivity and 62.2% specificity (AUC=0.657). Kaplan-Meier analysis revealed increasing mortality over time in the low HALP score group (log-rank tests, 1-year=44.86, p<0.001; 5-year=108.54, p<0.001). Conclusions: The HALP score is a simple, accessible measure, and our findings suggest that lower HALP scores are associated with increased 1-year and 5-year mortality in NVAF patients. This provides a reference for clinicians assessing risk in this vulnerable population.