Search Results (67)

Background/Objectives: Prognostic stratification in non-metastatic nasopharyngeal carcinoma (NPC) remains challenging, particularly among patients within the same TNM stage. Readily available hematologic inflammatory indices may reflect host–tumor interactions and provide additional prognostic information beyond conventional clinicopathologic factors. This study evaluated the prognostic value of pretreatment hematologic inflammatory indices for overall survival (OS) and progression-free survival (PFS) in patients with non-metastatic NPC. Methods: This single-center retrospective cohort study included adult patients with non-metastatic NPC diagnosed at a tertiary referral center between 20 February 2014 and 2 May 2023, with outcomes ascertained through 12 December 2023. Pretreatment complete blood count and biochemical parameters were used to calculate the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, pan-immune-inflammation value (PIV), and hemoglobin–albumin–lymphocyte–platelet score. Receiver operating characteristic analysis determined optimal cut-off values for mortality discrimination. Associations with OS and PFS were assessed using Cox regression models. Results: Forty-six patients were analyzed, including 37 males. Median OS and PFS were 45.90 and 37.05 months, respectively. Compared with survivors, non-survivors were older and had lower hemoglobin and albumin levels, higher PIV, NLR, PLR, and SII values, and lower HALP scores. Although NLR showed the highest conventional ROC performance for mortality discrimination, PIV retained prognostic significance in multivariable Cox models and showed stable time-dependent discrimination for PFS. Conclusions: These preliminary findings suggest that pretreatment inflammatory indices, particularly composite markers such as PIV, may provide adjunctive prognostic information in treatment-naïve non-metastatic NPC, pending larger prospective validation. Full article

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition), associated with high mortality in intensive care unit (ICU) patients. Composite immune–nutritional indices derived from routine laboratory data have emerged as accessible prognostic tools; however, their comparative value in critically ill septic patients remains insufficiently characterised. This study aimed to compare the prognostic performance of the haemoglobin–albumin–lymphocyte–platelet (HALP) score, pan-immune-inflammation value (PIV), and Naples Prognostic Score (NPS) for predicting in-hospital mortality in ICU patients with sepsis as the primary outcome, and to assess their incremental predictive value as the secondary objective. Methods: In this retrospective, two-centre cohort study, 1020 consecutive eligible adult patients fulfilling Sepsis-3 criteria (suspected or confirmed infection with an acute increase in SOFA score ≥ 2 points) admitted to the ICUs of Necmettin Erbakan University Hospital and Beyhekim Training and Research Hospital between January 2016 and June 2025 were included. HALP was calculated as haemoglobin (g/L) × albumin (g/L) × lymphocyte count (×10⁹/L) ÷ platelet count (×10⁹/L); PIV as (neutrophil × platelet × monocyte) ÷ lymphocyte (all ×10⁹/L). NPS was computed from serum albumin, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio, with the total-cholesterol component imputed due to availability in only 31.7% of patients. Discriminative performance was evaluated by receiver operating characteristic (ROC) analysis, pairwise DeLong tests, bootstrap resampling (1000 iterations), Hosmer–Lemeshow calibration, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analyses. Five pre-specified nested multivariable logistic regression models were constructed. Results: Of 1020 patients (median age 76 years, IQR 67–83; 59.8% male), 521 (51.1%) died during hospitalisation. HALP showed the highest discriminative ability among individual indices (AUC 0.626, 95% CI 0.594–0.658), while PIV was non-discriminatory (AUC 0.504, p = 0.78) and NPS showed limited performance (AUC 0.563, 95% CI 0.531–0.595). HALP remained an independent predictor of mortality after multivariable adjustment (OR 0.98, 95% CI 0.97–0.99, p = 0.002). NRI and IDI analyses showed no incremental value with NPS addition. Conclusions: HALP demonstrated modest but independently consistent discrimination for in-hospital mortality in ICU patients with sepsis, outperforming PIV and NPS. However, an AUC of 0.626 does not support standalone clinical use; external validation and comparison with established severity models are required before integration into risk stratification frameworks. Full article

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma. Despite advances in immunochemotherapy, approximately 30–40% of patients experience relapsed or refractory disease. Nutritional and inflammatory status, reflected by composite indices, may independently influence clinical outcomes. However, the prognostic value of the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score has not been well established in DLBCL patients treated with rituximab-based regimens. Methods: We retrospectively analyzed 192 patients with newly diagnosed DLBCL who received at least three cycles of R-CHOP or R-EPOCH at Başakşehir Çam and Sakura City Hospital between January 2020 and January 2026. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoff values. Kaplan–Meier analysis with log-rank testing and univariable/multivariable Cox proportional hazards regression analyses were used to evaluate the prognostic impact of the PNI, GNRI, and HALP on overall survival (OS) and progression-free survival (PFS). Results: Among the six indices evaluated (PNI, GNRI, HALP, SII, ALI, and CAR), the PNI demonstrated the highest discriminatory ability for OS (AUC = 0.734, p = 0.001), followed by the HALP (AUC = 0.671, p = 0.020) and GNRI (AUC = 0.668, p = 0.022). The optimal cutoff values were ≤46.45 for the PNI, ≤46.91 for the GNRI, and ≤223.95 for HALP. Low values of all three indices were significantly associated with elevated LDH levels, advanced Ann Arbor stage, and higher IPI category. Kaplan–Meier analysis demonstrated significantly inferior OS in the low PNI (52.8 ± 2.6 vs. 67.1 ± 1.2 months, p = 0.001), low GNRI (49.5 ± 3.1 vs. 66.0 ± 1.4 months, p = 0.001), and low HALP (58.8 ± 2.8 vs. 64.9 ± 1.2 months, p = 0.005) groups. In separate multivariable Cox models adjusted for sex and IPI, the PNI (HR = 0.216, p = 0.009), HALP (HR = 0.276, p = 0.031), and GNRI (HR = 0.294, p = 0.011) remained independently associated with OS. No significant association was observed between these indices and PFS. Conclusions: The PNI, GNRI, and HALP are independent prognostic markers in patients with DLBCL treated with rituximab-based regimens. These readily available and inexpensive baseline indices may complement the IPI in identifying patients at higher risk of adverse outcomes and support risk stratification at diagnosis. Full article

Background and Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease characterized by recurrent inflammatory attacks and a persistent psychosocial burden. Although generalized anxiety symptoms have been investigated in FMF, disease-specific anticipatory concerns related to recurrent attacks remain insufficiently understood. This study aimed to investigate the associations of attack-related anticipatory anxiety symptoms with clinical characteristics, quality of life, and composite inflammatory indices in FMF. Materials and Methods: This exploratory cross-sectional study included 38 adult patients with FMF. Attack-related anticipatory anxiety symptoms were assessed using an exploratory six-item questionnaire. Generalized anxiety and quality of life were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Short-Form–12 (SF-12), respectively. Composite inflammatory indices including the C-reactive protein–albumin–lymphocyte (CALLY) index, log-CALLY, hemoglobin–albumin–lymphocyte–platelet (HALP) score, and systemic immune-inflammation index (SII) were calculated from routine laboratory parameters. Results: Attack-related anticipatory anxiety scores demonstrated a significant positive correlation with GAD-7 scores (r = 0.581, p < 0.001) and an inverse correlation with SF-12 mental component scores (r = −0.380, p = 0.019). Direct correlations between attack-related anticipatory anxiety scores and composite inflammatory indices were weak and not statistically significant. In subgroup analysis, a higher annual attack burden was associated with higher GAD-7 scores, higher CRP and serum amyloid A values, and lower CALLY, log-CALLY, and HALP values. Differences in attack-related anticipatory anxiety, SF-12 MCS, and SII between attack burden groups did not reach statistical significance. In multivariable linear regression analysis, GAD-7 score remained independently associated with attack-related anticipatory anxiety symptoms (β = 0.438, p = 0.010). Conclusions: Attack-related anticipatory anxiety symptoms may represent an exploratory psychosocial dimension of FMF associated mainly with generalized anxiety symptoms and impaired mental well-being. Composite inflammatory indices appeared more closely related to annual attack burden than to attack-related anticipatory anxiety. These findings should be interpreted cautiously and considered hypothesis-generating. Full article

Background: Heart failure (HF) remains a major early complication following myocardial infarction (MI), contributing significantly to morbidity and adverse clinical outcomes. Reliable early risk stratification is essential for optimizing post-MI management. This study aimed to evaluate the prognostic performance and incremental value of the HALP (Hemoglobin–Albumin–Lymphocyte–Platelet) score and the AHEAD score in predicting 1-month HF after MI. Methods: This retrospective cohort study included 3205 consecutive patients with MI. The primary endpoint was the development of HF within one month. Three multivariable logistic regression models were constructed: a baseline clinical model (Model 1), a HALP-integrated model (Model 2), and an AHEAD-integrated model (Model 3), with component variables excluded to avoid collinearity. Model performance was assessed using odds ratios (ORs), 95% confidence intervals (CIs), and discrimination metrics (AUC). Incremental predictive value was further evaluated using net reclassification improvement (NRI). Internal validation was performed using bootstrapping and 5-fold cross-validation. A predefined subgroup analysis was conducted in patients with preserved ejection fraction (EF ≥ 40%), excluding EF from the models. Results: In the full cohort, all models demonstrated high discriminative ability for 1-month HF (AUC range: 0.950–0.954), with minimal differences between models. The AHEAD-based model showed the highest point estimate (AUC = 0.954, 95% CI: 0.944–0.963), but ROC curves were largely overlapping. Despite limited changes in AUC, the AHEAD score provided moderate improvement in risk reclassification (NRI = 0.287), whereas the HALP score showed minimal incremental value (NRI = 0.152) and was not independently associated with HF in multivariable analysis. In the EF ≥ 40 subgroup, HF incidence was lower (1.9%), and model performance was attenuated but remained robust (AUC range: 0.839–0.882), with the AHEAD score retaining strong independent predictive value. Peak CKMB and creatinine were consistently associated with increased HF risk. Although the odds ratio for CKMB appeared close to unity, this reflects unit scaling, and clinically meaningful increases corresponded to substantial risk increments. A clear dose–response relationship between AHEAD score and HF probability was observed. Conclusions: While both HALP and AHEAD scores are associated with post-MI HF risk, only the AHEAD score provides consistent independent and incremental prognostic value beyond established clinical predictors. Its simplicity and ability to capture comorbidity burden make it a practical adjunct for early risk stratification, particularly in patients with preserved EF. However, given the minimal differences in discrimination metrics and lack of external validation, these findings should be interpreted cautiously and considered hypothesis-generating. Full article

Background: Acute respiratory distress syndrome (ARDS) remains one of the most serious causes of respiratory failure and mortality in critically ill patients. Although the Berlin Definition provides a standardized framework for diagnosis, it offers limited predictive value for clinical outcomes. In this context, there is growing interest in the use of routinely available hematological markers as practical tools for early risk stratification. This study aimed to examine the association between hematological parameters and mortality in patients with ARDS, with particular emphasis on complete blood count-derived inflammatory indices. Methods: This multicenter retrospective cohort study included 404 adult patients with a confirmed diagnosis of ARDS who were admitted to intensive care units in Saudi Arabia. Demographic, clinical, and laboratory data were collected from electronic medical records. In addition to standard hematological parameters, the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and hemoglobin–albumin–lymphocyte–platelet (HALP) score were calculated from admission laboratory findings. Comparisons between survivors and non-survivors were performed using non-parametric statistical tests, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the prognostic performance of these indices for in-hospital mortality. Results: Of the 404 included patients, 295 survived, and 109 died during hospitalization. Non-survivors demonstrated significantly higher white blood cell and neutrophil counts, alongside significantly lower lymphocyte, eosinophil, hemoglobin, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and albumin levels. The derived inflammatory indices further demonstrated clear differences between outcome groups, as NLR and SII were significantly higher in non-survivors, whereas HALP scores were significantly lower. In ROC analysis, NLR showed the strongest discriminatory ability for mortality (AUC = 0.80, 95% CI 0.74–0.85), followed by SII (AUC = 0.76, 95% CI 0.71–0.81) and HALP (AUC = 0.76, 95% CI 0.70–0.81). The optimal cutoff values were 4.26 for NLR, 958 for SII, and 2.15 for HALP. No significant correlations were identified between age and any of the three indices. Upon applying multivariable regression analysis, only NLR maintained its prognostic ability for ARDS-related mortality. Conclusions: Routine hematological parameters, together with derived inflammatory and nutritional indices, were significantly associated with mortality in patients with ARDS. Among the evaluated markers, NLR demonstrated the strongest prognostic performance, both in univariate and multivariate analysis, followed by SII and HALP. As these indices are derived from inexpensive, readily available laboratory tests, they may offer practical value for early risk stratification and clinical decision-making, particularly in resource-limited settings. Full article

Background: Bronchiectasis is a heterogeneous chronic inflammatory airway disease characterized by recurrent exacerbations. Data on composite inflammatory biomarkers for assessing disease activity remain limited. Methods: This retrospective study included 97 patients with non-cystic fibrosis bronchiectasis categorized as stable (n = 39) or with exacerbated bronchiectasis (n = 58). Demographic, clinical, and laboratory data were analyzed, and inflammatory indices—NLR (neutrophil–lymphocyte ratio), PLR (platelet–lymphocyte ratio), SII (Systemic Immune-Inflammation Index), PIV (Pan-Immune-Inflammation Value), CAR (C-reactive protein-to-albumin ratio), and HALP score (hemoglobin × albumin × lymphocyte/platelet)—were calculated, followed by multivariate logistic regression and ROC analyses. Results: Patients with bronchiectasis exacerbations had a higher NLR, PLR, PIV, SII, and CAR and lower HALP (all p < 0.001). The C-reactive protein-to-albumin ratio demonstrated the highest discriminative ability (AUC = 0.995), followed by SII and NLR, while lower HALP and SII were independent predictors of exacerbation. The C-reactive protein-to-albumin and sedimentation-to-albumin ratios were strongly correlated with hospitalization duration (both p < 0.001). Conclusions: Composite inflammatory indices are strongly associated with disease activity in bronchiectasis. CAR showed excellent discriminative performance, while HALP and SII independently predicted exacerbation. These simple, cost-effective biomarkers may support risk stratification and clinical monitoring in routine practice. Full article

Background: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis characterized by chronic inflammation, endothelial dysfunction, and high residual risk of major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). This review aimed to summarize the prognostic role of inflammatory biomarkers in PAD and to discuss their therapeutic implications. Methods: A comprehensive narrative review was performed using PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library, focusing mainly on English-language studies published in recent years. Randomized trials, observational studies, systematic reviews, and meta-analyses evaluating inflammatory biomarkers and anti-inflammatory or vasculoprotective therapies in PAD were included. Results: Both classical and emerging inflammatory biomarkers were associated with PAD severity and adverse outcomes. C-reactive protein, fibrinogen, interleukins, tumor necrosis factor-α, myeloperoxidase, galectin-3, and growth differentiation factor-15 showed prognostic value for MACEs, MALEs, restenosis, amputation, and mortality. Among newer indices, the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, C-reactive protein-to-albumin ratio, and HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) score appear especially promising for risk stratification. Anti-inflammatory and pleiotropic therapies, including canakinumab, colchicine, statins, and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, may help reduce residual inflammatory risk. Conclusions: Inflammatory biomarkers may improve prognostic stratification and support more personalized management in PAD. Their integration into clinical practice could enhance limb preservation and long-term cardiovascular outcomes. Full article

Background: Desmoid tumors (DT) are rare, locally aggressive neoplasms characterized by an unpredictable clinical course. Although anatomical localization has been associated with tumor behavior, its relationship with systemic inflammatory response remains insufficiently explored. This study aimed to evaluate the impact of tumor localization on systemic inflammatory markers and to investigate CD47 expression in DT. Methods: This retrospective cohort study included 127 patients diagnosed with DT between 2010 and 2023. Demographic, clinicopathological, and laboratory data were collected. Systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), HALP score, and pan-immune-inflammation value (PIV), were calculated. Tumor localization was categorized as trunk, extremity, or head and neck. CD47 expression was evaluated by immunohistochemistry. Results: Tumors were most frequently located in the trunk (50.4%), followed by extremities (40.9%) and head and neck region (8.7%). Significant differences in inflammatory markers were observed according to tumor localization. The head and neck group demonstrated lower neutrophil counts (p = 0.020), NLR (p = 0.009), PLR (p < 0.001), and PIV (p = 0.003), while showing higher PNI (p = 0.043) and HALP scores (p = 0.001) compared to trunk-localized tumors. Additionally, smaller tumors (<49 mm) were associated with lower NLR (p = 0.041) and neutrophil counts (p = 0.015). No detectable CD47 expression was observed in any tumor samples. Conclusions: Anatomical localization is closely associated with distinct systemic inflammatory profiles in patients with DT. These findings suggest that tumor location may influence host immune–inflammatory interactions and contribute to the biological heterogeneity of DT. The absence of CD47 expression indicates that alternative immune-related mechanisms may play a role in DT biology. Easily accessible inflammatory markers may provide valuable insights for risk stratification in clinical practice. Full article

Background and Objectives: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is an immunonutritional biomarker reflecting systemic inflammation, nutritional status, and immune competence. Its dynamic behavior and prognostic relevance in multiple myeloma (MM) following autologous stem cell transplantation (ASCT) remain insufficiently characterized. Materials and Methods: In this retrospective cohort study, 95 MM patients undergoing ASCT were analyzed. HALP scores were calculated at diagnosis and at post-transplant day +100, and dynamic changes (ΔHALP) were assessed. Associations with overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan–Meier and multivariable Cox regression analyses, with maintenance therapy incorporated as a covariate. Results: During a median follow-up of 50 months (range: 11.0–144.0), 36.8% of patients progressed or relapsed, and 23.2% died. Baseline HALP was associated with both OS and PFS in unadjusted analyses; however, the inverse association at diagnosis was substantially attenuated after adjustment for maintenance therapy (HR: 0.71, 95% CI: 0.28–1.80; p = 0.466). HALP at day +100 showed a robust association with PFS that strengthened after adjustment (HR: 3.27, 95% CI: 1.45–7.38; p = 0.004). The discriminative performance for treatment response was limited, with 95% CIs encompassing AUC = 0.50. Conclusions: Post-transplant HALP at day +100 emerged as the most robust HALP-based prognostic indicator for PFS. Given the small sample size, limited OS events (n = 22), use of outcome-driven cut-offs, and absence of cytogenetic and minimal residual disease data, dynamic HALP assessment may provide exploratory prognostic information warranting validation in larger, prospective, multi-center cohorts. Full article

Background/Objectives: Patients with hematologic malignancies represent a high-risk population requiring intensive care due to infections, organ failure, and treatment-related complications. Despite advances in oncologic therapies and intensive care management, mortality remains high. This study aimed to evaluate prognostic factors and clinical outcomes in critically ill patients with hematologic malignancies admitted to the intensive care unit (ICU). Methods: Adult patients (≥18 years) with hematologic malignancies who were admitted to a medical ICU and stayed for at least 48 h were retrospectively included. Demographic characteristics, laboratory parameters, and APACHE II, SOFA, EASIX, and HALP scores, as well as mortality and organ support requirements, were evaluated. Results: A total of 108 patients were included. The median age was 61 years (IQR: 49–70), and 61% were male. The 28-day mortality was 64.8%. Overall, 83.3% of patients required invasive mechanical ventilation for at least 24 h. The median ICU length of stay was 5 days (IQR: 3–10). Median APACHE II and SOFA scores were 22 (IQR: 16–28) and 9 (IQR: 6–11), respectively. In multivariate analysis, SOFA score (OR: 1.218, 95% CI: 1.022–1.451) and the highest BUN level during ICU stay (OR: 1.034, 95% CI: 1.008–1.060) were independently associated with intubation. Admission creatinine level was the only independent predictor of renal replacement therapy (OR: 1.948, 95% CI: 1.081–3.510). APACHE II score was the only variable independently associated with 28-day mortality (OR: 1.064, 95% CI: 1.002–1.129). Conclusions: APACHE II showed a modest but statistically significant association with 28-day mortality in this cohort. Intubation and RRT requirements were mainly associated with organ dysfunction severity and renal impairment. Larger multicenter studies are needed to validate these findings and to better define risk stratification in critically ill hematologic patients. Full article

Objective: Due to the varied clinical manifestations of acute pancreatitis (AP), prompt identification of patients predisposed to extended hospitalization is essential for efficient resource allocation. This study assessed the predictive efficacy of inflammatory and immunonutritional ratios—namely, C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin, albumin, lymphocyte, and platelet score (HALP)—in predicting hospitalizations lasting more than 7 days. Methods: A retrospective cohort analysis was performed on 306 patients treated at a tertiary center from June 2020 to June 2025. We used Mann–Whitney U tests, ROC analysis, and multivariate logistic regression models to evaluate the relationship between admission laboratory-derived ratios and length of stay. Results: In total, 27.5% (n = 84) of the cohort experienced prolonged hospitalization. Individual markers exhibited moderate discrimination; however, procalcitonin and CAR displayed high negative predictive values (>85%), demonstrating clinical utility in excluding prolonged hospital stays. Multivariate analysis revealed advanced age (p < 0.001) and increased CAR (p < 0.001) as the most significant independent predictors. On the other hand, the HALP score was much lower in the group that stayed longer, but it was not an independent predictor in the multivariate model. Conclusions: Older age and a higher CAR are both independent factors that can predict longer hospital stays in AP. The high negative predictive value of CAR is important because it represents a reliable way to exclude prolonged hospitalization. Low CAR levels at admission may help clinicians identify patients eligible for early discharge, thereby optimizing bed management. Full article

Objectives: Soft tissue sarcomas (STS) are biologically heterogeneous malignancies with unpredictable clinical behavior. Although tumor size, histological grade, and surgical margin status remain the main determinants of prognosis, additional biomarkers that integrate tumor biology and host-related factors are needed. The hemoglobin × albumin × lymphocyte/platelet (HALP) score reflects systemic inflammation and nutritional status. This study aimed to evaluate the association between preoperative HALP score and oncological as well as surgical outcomes in patients undergoing curative resection for STS. Materials and Methods: A retrospective cohort study was conducted including 46 consecutive patients who underwent surgery for STS between 2017 and 2025. HALP scores were calculated using preoperative laboratory parameters, and patients were stratified into low- and high-HALP groups according to the cohort median (24.9). Overall survival (OAS) and disease-free survival (DFS) were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Surgical margin status and postoperative complications were also compared. Results: Patients with low HALP scores had significantly larger tumors, higher rates of non-R0 resection, and increased major complications (p < 0.05). Recurrence and mortality were more frequent in the low-HALP group. Kaplan–Meier analysis demonstrated significantly shorter OAS (log-rank p = 0.0034) and DFS (log-rank p = 0.0318) in patients with low HALP scores. In univariate Cox analysis, HALP was significantly associated with survival outcomes; however, in multivariate analysis, histological grade and surgical margin status remained independent prognostic factors, while HALP lost independent significance. Conclusions: A low preoperative HALP score is associated with aggressive tumor characteristics, increased surgical morbidity, and poorer survival in STS patients. Although HALP did not retain independent significance in multivariable analysis, its strong association with tumor aggressiveness and survival suggests that it may reflect the systemic manifestation of high-risk tumor biology. As a simple and cost-effective biomarker derived from routine laboratory parameters, HALP may support preoperative risk stratification and help identify patients with biologically aggressive disease. Full article

Background: Accurate prognostic stratification remains essential for optimizing outcomes in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT). The hemoglobin–albumin–lymphocyte–platelet (HALP) score is a composite biomarker reflecting systemic inflammation, nutritional status, and immune competence, and has demonstrated prognostic value in several malignancies. This study aimed to evaluate the predictive utility of the HALP score for survivals and recurrence in HCC patients undergoing LT. Methods: A total of 476 consecutive patients who underwent LT for HCC between 2006 and 2024 were retrospectively analyzed. Pretransplant HALP scores were calculated for all patients. Receiver operating characteristic (ROC) analysis identified an optimal cut-off value of 29 for recurrence prediction. Patients were stratified into HALP ≥ 29 and HALP < 29 groups. DFS and recurrence rates were compared. Prognostic performance was assessed using the concordance index (C-index) and area under the ROC curve (AUC). Outcomes were further compared with the Milan and Expanded Malatya criteria. Results: Of the 476 patients, 335 (70.4%) had HALP ≥ 29 and 141 (29.6%) had HALP < 29. The HALP ≥ 29 group demonstrated significantly higher 5- and 10-year DFS rates compared with the HALP < 29 group (67.1% vs. 58.5% and 49.5% vs. 33.5%, respectively; p < 0.001). Recurrence rates were significantly lower in the HALP ≥ 29 group (14.0% vs. 31.9%; p < 0.001). However, patients within the Milan and Expanded Malatya criteria showed superior long-term DFS and lower recurrence rates in the HALP ≥ 29 compared to the HALP < 29 group (p ≤ 0.037). HALP ≥ 29 was associated with lower tumor burden parameters and improved hepatic functional reserve. Despite its significance, HALP demonstrated inferior discriminative performance (C-index: 0.565) compared with the Milan (0.621) and Expanded Malatya (0.648) criteria. Patients beyond the Milan criteria (n = 233) with HALP ≥ 29 achieved a 5-year overall survival of 54.2%, compared with 37.8% with HALP < 29. Conclusions: Low HALP score is associated with poor DFS and a high post-transplant recurrence rate. Although it represents a non-invasive and cost-effective biomarker, its prognostic accuracy remains inferior to established transplant selection criteria, limiting its use as a standalone selection tool. However, individuals beyond Milan with HALP ≥ 29 achieved survival outcomes exceeding internationally accepted post-transplant benchmarks. Incorporating HALP into pre-transplant evaluation may help identify a biologically favorable subgroup among patients traditionally considered high risk based solely on tumor burden. Full article

Background: Infective endocarditis (IE) remains associated with high morbidity and mortality despite advances in diagnostic and therapeutic strategies. Markers reflecting both inflammatory burden and nutritional status may improve early risk stratification. The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a composite index integrating hematologic and nutritional parameters; however, its prognostic value in IE has not been well established. Methods: This two-center retrospective cohort study included 218 adult patients hospitalized with IE between January 2016 and January 2025. HALP score was calculated from admission laboratory values. The primary outcome was in-hospital mortality, and 1-year mortality was evaluated as a secondary outcome. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value. Patients were categorized into low- and high-HALP groups, and survival was assessed using Kaplan–Meier analysis. Cox regression analyses were performed to identify independent predictors of in-hospital mortality. Results: A total of 218 patients were analyzed. In-hospital mortality occurred in 38.5% of patients. HALP score was significantly lower in non-survivors and was independently associated with in-hospital mortality. ROC analysis demonstrated good discriminatory performance (AUC 0.784), with an optimal cut-off value of 15.1 (sensitivity 73.9%, specificity 73.8%). Low HALP scores were associated with more advanced functional status, more frequent intracardiac complications, and higher rates of acute heart failure, renal failure, and septic shock. One-year mortality was also higher in the low-HALP group (42.9% vs. 18.2%, p = 0.005). Conclusions: HALP score is independently associated with in-hospital mortality in patients with IE and identifies a subgroup with more severe disease and worse outcomes. As an easily calculated parameter, it may serve as a complementary tool for risk stratification and clinical decision-making. Full article