Predictive Value of the HALP Score for Post-Operative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

Post-operative atrial fibrillation (POAF) is common after coronary artery bypass graft (CABG) surgery, occurring in 20% to 40% of patients and significantly increasing morbidity. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a composite nutritional-inflammatory index, is a prognostic marker in cardiovascular disease. However, its predictive value for POAF remains unestablished. We aimed to evaluate the predictive performance of 5 nutritional-inflammatory indices (HALP, Naples score, Systemic Immune-Inflammation Index [SII], neutrophil percentage-to-albumin ratio [NPAR], and C-reactive protein-albumin-lymphocyte [CALLY] index) for POAF and internally validate a novel prediction model incorporating HALP. Among 448 patients undergoing CABG, POAF occurred in 131 (29.2%). The HALP score demonstrated the highest discriminative ability (area under curve [AUC] 0.812), significantly ( P < .001) outperforming Naples (AUC 0.676), NPAR (AUC 0.730), SII (AUC 0.726), and CALLY (AUC 0.684). Adding HALP to the Least Absolute Shrinkage and Selection Operator (LASSO)-derived base model significantly improved discriminative ability (AUC 0.813-0.897; P < .001) and net clinical benefit across threshold probabilities. The combined model achieved a bootstrap-corrected AUC of 0.885 with a calibration slope of 0.909, reflecting excellent internal validity. HALP was the strongest POAF predictor in the combined model. The HALP-integrated model showed excellent performance, offering a practical tool for preoperative POAF risk stratification.