The Prognostic Value of the HALP Score in Predicting In-Hospital Mortality in Patients with Acute Ischemic Stroke

Objective: Acute ischemic stroke (AIS) is associated with substantial in-hospital mortality, and early risk stratification remains a clinical challenge. Immunonutritional status has emerged as a relevant determinant of outcomes in acute cerebrovascular events. This study aimed to investigate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting in-hospital mortality among patients with AIS. Methods: This single-center retrospective cohort study included 280 consecutive patients admitted with AIS between January 2023 and October 2024. Demographic data, clinical severity scores including the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), laboratory parameters, and radiological findings were recorded. Independent associations with in-hospital mortality were evaluated using multivariate logistic regression analysis adjusted for clinical severity indices. The discriminative performance of the HALP score was assessed using receiver operating characteristic (ROC) curve analysis. Results: The overall in-hospital mortality rate was 28.9%. Non-survivors demonstrated significantly higher NIHSS and mRS scores, elevated C-reactive protein levels, and lower HALP, hemoglobin, and albumin values compared with survivors. In-hospital complications were more frequent among non-survivors (79%). After multivariate adjustment, NIHSS, mRS, C-reactive protein, and a lower HALP score remained independently associated with in-hospital mortality. The HALP score showed moderate discriminative ability (AUC: 0.735; 95% CI: 0.665–0.804). A cut-off value of 24.5 provided high specificity (83.4%) for predicting mortality. Conclusion: Lower HALP scores were independently associated with in-hospital mortality in acute ischemic stroke, suggesting that this readily available immunonutritional index may provide complementary prognostic information to established clinical severity scales, although prospective multicenter validation is required.