Can HALP help in identifying transcatheter aortic valve replacement patients at risk?

Abstract Background Typical transcatheter aortic valve replacement (TAVR) candidates include elderly, often frail patients with multiple comorbidities. With evergrowing research on impact of nutritional status and inflammatory response in TAVR patients, there is an ongoing search for easily utilized scores that could identify patients at risk of complications. One of such is the HALP score, initially developed for risk stratifying oncological patients using readily available laboratory parameters, combined in a formula that includes hemoglobin, albumin, lymphocites and plateles. Given the simplicity of the score, its use could potentially be extended onto TAVR patients, however current research is available on a small number of patients. (1) Purpose The aim of this research is to investigate whether altered HALP score is associated with adverse outcomes in patients undergoing TAVR Methods We conducted a registry based study on 638 patients who underwent TAVR at our institution from November 2012 to January 2025. HALP score was calculated using the formula by the original authors (hemoglobin x albumin x lymphocites / platelets) from blood samples drawn at admission for procedure. (2) Results Median age was 80 years (interquartile range (IQR) 76-84), 329 patients were male (52%), median NTproBNP was 2228 pg/nl (IQR 766-5397), median left ventricular ejection fraction was 55% (IQR 45-60), median mean pressure gradient and aortic valve area were 46 mmHg (IQR 38-58) and 0.7 cm2 (IQR 0.6-0.9), respectively. Median HALP score was 36 (IQR 24-50). Patient sociodemographic and clinical data is shown in Table 1. We used ROC curve analysis to define the cut-off point for the HALP score, values 25 and below were considered low, while above 25 were considered normal. Patients with low HALP had statistically significantly more atrial fibrillation, lower ventricular ejection fraction and aortic valve area, as well as mean pressure gradient, while Charlson comorbidity index was higher in the low HALP group (data shown in Table 1). Patients with low HALP had a significantly lower survival time compared to the normal HALP group (15 ( IQR 9-21) vs 18 (IQR 12-26) months; HR 1.62 (1.1-2.39), P=0.015), as well as shorter time to MACE (14 (IQR 6-25) vs 27 (IQR 15-64) months; HR 3.06 (1.46-6.4), P=0.003). There was no significant difference in early postprocedural complications between the two groups (45 (27%) in low vs 121 (73%) in normal HALP group, P 0.811). Conclusion Patients with more comorbidities, lower ejection fraction and more advanced aortic stenosis seem to have a lower HALP, reflecting worse overall fitness for procedure. Our data shows that lower HALP score is significantly associated with negative long term outcomes in TAVR patients. Further research is neccessary to establish ways of optimizing patients at risk, thus potentially reducing complications post-implantation.Table 1