Comparative predictive performance of HALP score and prognostic nutritional index for mortality in ICU patients after hip fracture surgery

Hip fractures in elderly patients are associated with high morbidity and mortality. Simple and reliable prognostic biomarkers are needed to complement clinical risk assessment Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score and Prognostic Nutritional Index (PNI) reflect nutritional and immunological status and may predict postoperative outcomes. We aimed to investigate the association of preoperative HALP score and PNI with 1-year all-cause mortality in elderly patients admitted to the intensive care unit (ICU) after surgical treatment for hip fractures. A retrospective study was performed on 257 patients aged 65 years and older who were admitted to the ICU following surgical intervention for hip fractures. Demographic information, comorbidities, and laboratory results were all gathered. The patients were categorized into two groups: non-survivors ( n = 40) and survivors ( n = 217). Univariable and multivariable Cox regression analyses were performed to identify independent predictors of 1-year all-cause mortality. Non-survivors had significantly lower PNI (34.1 ± 7.7 vs. 37.9 ± 6.6; p = 0.004) and HALP scores (median 11.3 vs. 17.3; p = 0.003). Two separate multivariable Cox regression analysis models were performed for PNI and HALP. In both models, male gender, malignancy, and a high Charlson Comorbidity Index were identified as independent predictors of mortality. While HALP was not an independent predictor of mortality in the multivariable analysis, low PNI (HR 0.928; 95% CI 0.874–0.987; p = 0.017) was found to be an independent predictor of all-cause mortality at 1 year. ROC analysis demonstrated limited discriminative power for PNI (AUC 0.642) and HALP (AUC 0.648). Preoperative PNI was an independent predictor of mortality in elderly hip fracture patients, whereas HALP showed limited prognostic value. These simple nutritional indices may aid early risk stratification and guide perioperative care.