Demir Yusuf, Yamak Betül Ayça, Sevinç Samet, Karakurt Hüseyin, Tükenmez Karakurt Seda, Kadiroğulları Ersin, Aydın Saadet, Kızıltunç Emrullah, Babur Güler Gamze, Candemir Mustafa
Department of Cardiology, Bakırçay University, Çiğli Training and Research Hospital, İzmir, Türkiye.
Department of Cardiology, Hopa State Hospital, Artvin, Türkiye.
J Inflamm Res. 2025 Aug 8;18:10637-10649. doi: 10.2147/JIR.S517577. eCollection 2025.
Tricuspid valve surgery is associated with significant perioperative and long-term risks. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score is an integrated biomarker reflecting nutritional, inflammatory, and hematologic status. HALP score has proven prognostic utility, yet its relevance in tricuspid valve surgery is not well established. This study aimed to evaluate the association between preoperative HALP score and both in-hospital and long-term mortality in patients undergoing tricuspid valve surgery.
This retrospective study included adult patients (≥18 years) who underwent isolated or combined tricuspid valve surgery between 2014 and 2021. The HALP score was calculated as platelet count × hemoglobin × albumin / lymphocyte count. Patients were grouped into low and high HALP score categories based on the mean HALP score. Laboratory parameters, echocardiographic findings, and mortality rates were compared. Laboratory and echocardiographic data, as well as mortality outcomes, were compared. Logistic regression was used to identify independent predictors of in-hospital mortality, while Cox proportional hazards and Kaplan-Meier analyses assessed long-term mortality. ROC curve analysis was performed to determine the optimal HALP cutoff.
Among 277 patients, 28 (10.1%) experienced in-hospital mortality and 45 (16.1%) died during follow-up. Patients who died had significantly lower HALP scores (p < 0.001). Univariate analysis showed that age, atrial fibrillation, EuroSCORE, low hemoglobin, low albumin, lymphopenia, low HALP score, chronic kidney disease, and perioperative complications were associated with in-hospital mortality. However, only advanced CKD and perioperative complications remained significant in multivariate analysis. HALP score was independently associated with long-term mortality (p < 0.001). The optimal HALP cutoff was 0.2998 (sensitivity 73.3%, specificity 73.7%; AUC = 0.817).
Lower preoperative HALP scores are associated with increased long-term mortality after tricuspid valve surgery. Although not predictive of in-hospital mortality, the HALP score may help identify high-risk patients using routine laboratory values.
三尖瓣手术伴随着显著的围手术期和长期风险。血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分是一种反映营养、炎症和血液学状态的综合生物标志物。HALP评分已被证明具有预后价值，但其在三尖瓣手术中的相关性尚未明确确立。本研究旨在评估三尖瓣手术患者术前HALP评分与住院期间及长期死亡率之间的关联。
这项回顾性研究纳入了2014年至2021年间接受单纯或联合三尖瓣手术的成年患者（≥18岁）。HALP评分计算为血小板计数×血红蛋白×白蛋白/淋巴细胞计数。根据平均HALP评分将患者分为低HALP评分组和高HALP评分组。比较实验室参数、超声心动图检查结果和死亡率。比较实验室和超声心动图数据以及死亡结局。采用逻辑回归确定住院死亡率的独立预测因素，同时采用Cox比例风险模型和Kaplan-Meier分析评估长期死亡率。进行ROC曲线分析以确定最佳HALP临界值。
277例患者中，28例（10.1%）在住院期间死亡，45例（16.1%）在随访期间死亡。死亡患者的HALP评分显著较低（p < 0.001）。单因素分析显示，年龄、心房颤动、欧洲心脏手术风险评估系统（EuroSCORE）、低血红蛋白、低白蛋白、淋巴细胞减少、低HALP评分、慢性肾脏病和围手术期并发症与住院死亡率相关。然而，在多因素分析中，只有晚期慢性肾脏病和围手术期并发症仍然具有显著性。HALP评分与长期死亡率独立相关（p < 0.001）。最佳HALP临界值为0.2998（敏感性73.3%，特异性73.7%；AUC = 0.817）。
术前较低的HALP评分与三尖瓣手术后长期死亡率增加相关。虽然HALP评分不能预测住院死亡率，但它可能有助于利用常规实验室值识别高危患者。
