Inflammatory and Nutritional Indices Associated with Histopathological Severity of Cervical Lesions in HPV-Positive Women

Abstract Objective This study aimed to evaluate the association of inflammatory and nutritional indices, including HALP (Hemoglobin × Albumin × Lymphocyte / Platelet), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII), with cervical intraepithelial neoplasia (CIN) grade and invasive disease in HPV positive women. Materials and Methods This retrospective observational study included 122 patients who underwent cervical biopsy between January 2020 and December 2025. Patients were classified according to the highest histopathological diagnosis as CIN1 ( n = 39), CIN2 ( n = 30), CIN3 ( n = 35), and squamous cell carcinoma (SCC) ( n = 18). Inflammatory indices (HALP, NLR, and SII) were calculated using routine hematological and biochemical parameters. Comparisons among histopathological groups were performed using one-way ANOVA with Tukey post-hoc tests. Multinomial logistic regression analysis was conducted to identify independent predictors of histopathological severity. Additional analyses were performed according to HPV oncogenic risk groups, including high risk HPV negative (HR (-)), HR HPV positive (+), HR HPV and ultra HR HPV positive (HR + UHR(+)). Results Age, NLR, SII and HALP scores significantly differed across histopathological groups, with SCC patients showing higher age, NLR, SII and lower HALP scores ( p < 0.001, p = 0.008, p = 0.02, p = 0.04 ; respectively). Serum albumin emerged as the strongest independent predictor separating CIN from SCC ( p < 0.001). HPV genotype influenced inflammatory profiles, with HR (+) associated with lower HALP and higher SII values ( p = 0.002 and p = 0.03). In multivariate analysis, NLR remained independently associated only with the CIN3–SCC comparison, whereas HALP and SII failed to reach statistical significance. Conclusion Serum albumin may represent a potential biomarker associated with invasive cervical disease, although its clinical relevance requires confirmation in larger prospective cohorts. Inflammatory indices such as HALP, NLR, and SII appear to reflect disease severity, but their predictive performance may be influenced by HPV oncogenic risk. These findings suggest a potential interaction between systemic inflammatory status and viral oncogenic burden in the progression of cervical neoplasia.