Hemoglobin-albumin-lymphocyte-platelet score and early neurological deterioration in acute ischemic stroke: a single-center retrospective cohort study

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Hemoglobin-albumin-lymphocyte-platelet score and early neurological deterioration in acute ischemic stroke: a single-center retrospective cohort study

• 

  Ci Zhang 1,2†

• 

  Wei Zhang 1†

• Y

  Yinyang Zhang 3

• 

  Guosong Xue 1*

• 1. Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

• 2. Department of Neurology, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu, China

Abstract

Purpose: 

To investigate the association between the hemoglobin-albumin-lymphocyte-platelet (HALP) score and early neurological deterioration (END) in individuals with stroke and to develop an exploratory prediction model for END.

Patients and methods: 

Clinical data from 595 patients with acute ischemic stroke (AIS) admitted to the Affiliated Hospital of Xuzhou Medical University from April 2022 to April 2024 were retrospectively analyzed. Patients were randomly divided into a training set and a validation set in a 7:3 ratio. Multivariable logistic regression analysis was utilized in the training data to examine END risk variables and build a corresponding predictive model. Model performance was evaluated using receiver operating characteristic (ROC) curves to assess discrimination and the Hosmer–Lemeshow goodness-of-fit test to evaluate calibration. Clinical decision curve analysis (DCA) was further applied to determine the model’s clinical value. To improve interpretability, the importance of included predictors was assessed using the SHapley Additive exPlanation (SHAP) method.

Results: 

Of the 595 patients, 186 (31.3%) developed early neurological deterioration (END), while the remaining 409 (68.7%) comprised the non-END group. The training cohort consisted of 416 randomly assigned participants. Multivariate logistic regression showed that the large artery atherosclerosis (LAA) subtype, elevated baseline National Institutes of Health Stroke Scale (NIHSS) score, and lower HALP score constituted independent determinants for END development (p < 0.05). In further stepwise-adjusted analyses, the association between HALP and END remained statistically significant after controlling for demographic characteristics, vascular risk factors, and treatment-related variables. A nomogram incorporating HALP score, LAA subtype, and baseline NIHSS score showed moderate discrimination in both the training and validation sets.

Conclusion: 

A lower HALP score was associated with END in patients with AIS. A nomogram incorporating HALP score, LAA subtype, and baseline NIHSS score demonstrated moderate discrimination and may provide useful information for early risk stratification in AIS. This prediction model requires validation in a larger, prospective clinical study.

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