Association of the HALP score with one-year mortality in emergency department patients with acute ischemic stroke: a retrospective cohort study

To evaluate the association of the hemoglobin-albumin-lymphocyte-platelet (HALP) score with one-year all-cause mortality and its discriminatory performance in patients with acute ischemic stroke presenting to the emergency department. This single-center retrospective cohort study included adults with a final discharge diagnosis of acute ischemic stroke who presented between 1 January and 31 December 2019. Of 1,202 records screened, 735 patients were included. HALP was calculated from the first available blood samples obtained at emergency department presentation as hemoglobin (g/L) × albumin (g/L) × lymphocyte count (×10⁹/L) / platelet count (×10⁹/L). One-year vital status was ascertained using e-Nabız, Türkiye’s national personal health record system. Multivariable logistic regression assessed the association with mortality after adjustment for age, sex, and selected comorbidities. Discrimination was assessed using receiver operating characteristic curve analysis. Among 735 patients, 185 (25.2%) died within one year. The median HALP score was lower in patients who died than in survivors (27.16 vs. 42.73; p < 0.001). After adjustment, each doubling of HALP was associated with lower mortality odds (adjusted odds ratio, 0.479; 95% CI, 0.385–0.596; p < 0.001). The area under the curve was 0.704 (95% CI, 0.659–0.750). The exploratory cut-off selected by maximizing the Youden index was approximately 25.73, with sensitivity of 49.2% and specificity of 84.0%, calculated using the unrounded threshold. Lower HALP scores remained associated with higher one-year all-cause mortality after adjustment for age, sex, and selected comorbidities. Discriminatory performance was moderate, and external validation is required before clinical application.