HALP Score as a Predictor of Six-Month Mortality in Acute Pulmonary Embolism Patients

Aim: This study evaluated the prognostic value of the Haemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score for six-month mortality in acute pulmonary thromboembolism (APTE) and its added value over established risk tools.Materials and Methods: In this retrospective cohort study, 556 patients with APTE confirmed by computed tomography pulmonary angiography (CTPA) were analysed between 2017 and 2024. HALP was calculated as (haemoglobin × albumin × lymphocytes) / platelets. Non-normally distributed variables are given as median (interquartile range) and compared with the Mann–Whitney U test. Independent predictors were identified by logistic regression and discrimination by ROC analysis. The incremental value of HALP over sPESI was assessed with the integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI), and internal validity by bootstrap optimism correction.Results: Mean age was 55 ± 17 years, 42.3% were male, and six-month mortality was 12.2% (n = 68). HALP was lower in non-survivors (median 0.98 vs 3.01; p < 0.001). The AUC was 0.767 (95% CI 0.713–0.822), with an optimal cut-off of 1.91 (sensitivity 79.4%, specificity 65.2%); HALP discriminated mortality better than each of its components (DeLong p < 0.05). In multivariable analysis, HALP (OR 0.66; 95% CI 0.55–0.79; p < 0.001), lactate, pulmonary arterial pressure and age were independent predictors. Adding HALP to sPESI raised the AUC from 0.612 to 0.791 (IDI 0.098; NRI 0.862), and the optimism-corrected AUC was 0.815. HALP remained independent in the malignancy subgroup (OR 0.66; p = 0.008).Conclusions: A lower HALP score is independently associated with six-month mortality in APTE and may add prognostic information to sPESI. As a simple, low-cost index it could complement guideline-based models. Given its limited specificity and the lack of external validation, these findings are hypothesis-generating pending prospective multicentre confirmation. The proposed HALP cut-off should not be applied in routine clinical practice until it has been externally validated in prospective multicentre cohorts.