The role of the HALP score in determining the severity of lower extremity peripheral arterial disease

Abstract

Objective

Peripheral artery disease (PAD) is a chronic circulatory disorder characterized by atherosclerotic plaque buildup in the peripheral vascular system, restricting blood flow to the lower extremities and carrying a significant risk of morbidity and mortality. This study investigates the role of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic marker for assessing the severity of lower extremity peripheral artery disease (LEAD). The HALP score integrates hematologic and nutritional markers, providing a composite index that may reflect both the inflammatory and nutritional states impacting LEAD progression.

Methods

A cross-sectional retrospective study was conducted, analyzing 186 patients diagnosed with LEAD through peripheral angiography. Participants were classified according to the TransAtlantic Inter-Society Consensus (TASC) II criteria, with mild to moderate disease (TASC A-B) and severe disease (TASC C-D). Laboratory data were collected within the first week of diagnosis, and HALP scores were calculated. The association between HALP scores and LEAD severity was evaluated through correlation and logistic regression analyses. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were also analyzed.

Results

Significant differences were observed between TASC A-B and TASC C-D groups in demographic and clinical variables. Patients in the severe LEAD group were older, had a higher prevalence of diabetes and hyperlipidemia, and exhibited lower hemoglobin and albumin levels with higher platelet counts (p < .001). A significant inverse correlation was found between HALP score and LEAD severity (R = −0.607, p < .001), indicating that lower HALP scores are associated with more advanced disease. The HALP score displayed strong discriminatory performance in ROC analysis (AUC = 0.889), with an optimal cut-off of 3.14 providing 81% sensitivity and 80% specificity for predicting severe LEAD.

Conclusion

The HALP score is a valuable, non-invasive predictor of LEAD severity and may serve as a practical tool for clinical risk assessment. Incorporating the HALP score into routine evaluation protocols could support more personalized management approaches for patients with LEAD, guiding both therapeutic decisions and long-term monitoring.