Association of hemoglobin, albumin, lymphocyte, and platelet score with all-cause and cardiovascular mortality in adults with diabetes or prediabetes: Results from NHANES 2005-2018.

OBJECTIVE

The relationship between the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and mortality in patients with diabetes/prediabetes remains uncertain. This study aimed to evaluate linear and non-linear associations between the HALP score and all-cause and cardiovascular mortality in this population and identify potential clinically relevant thresholds.

METHODS

We analyzed data from 19,350 United States adults with diabetes/prediabetes using two linked datasets: the National Health and Nutrition Examination Survey (NHANES, 2005-2018) and mortality records from the National Death Index (NDI), with follow-up through December 31, 2019. Kaplan-Meier survival curves, Cox proportional hazards models, and restricted cubic splines (RCS) were used to evaluate the HALP score and mortality associations.

RESULTS

Kaplan-Meier analysis revealed the highest all-cause mortality in Q1, the lowest all-cause mortality in Q3, and the lowest cardiovascular mortality in Q4 (-value <0.0001). Cox regression analysis demonstrated significantly reduced risks of all-cause mortality (HR 0.64, 95 % CI 0.58, 0.73) and cardiovascular mortality (HR 0.58, 95 % CI 0.42, 0.82) in Q4 compared to Q1. RCS identified an L-shaped association between the HALP score and mortality, with inflection points at 42.29 (all-cause) and 39.98 (cardiovascular).

CONCLUSION

An L-shaped association between the HALP score and both all-cause and cardiovascular mortality in participants with diabetes mellitus or prediabetes.