Evaluation of the relationship between Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score and treatment modality and mortality in patients with ileus

Abstract

BACKGROUND: Ileus is a clinical condition defined as obstruction of the intestines and develops as a result of a mechanical obstruction or paralytic etiologies. Small bowel obstructions are primarily referred to as surgical conditions, but conservative treatment is one of the treatment protocols of choice in some of patients. The aim of the present study was to evaluate the effectiveness of hemoglobin, albumin, lymphocyte, and platelet (HALP) score in determining the conservative versus surgical treatment decision, mor-tality, and length of hospitalization and demonstrate its superiority over other parameters thought to be associated with inflammation in patients with ileus. METHODS: Patients with a diagnosis of ileus were included in the study. Age, gender, comorbidities, selected treatment modality (conservative or surgical), length of hospitalization, and in-hospital mortality were determined and recorded. White blood cell, hemo-globin, platelet, neutrophil, lymphocyte, neutrophil, lymphocyte, urea, creatinine, aspartate aminotransferase (AST), bilirubin, albumin, and C-reactive protein (CRP) levels from biochemistry parameters were recorded. HALP score was calculated and the relationship with mortality, length of hospitalization, and conservative versus surgical treatment decision was analyzed. RESULTS: A total of 286 patients were included in the study. Conservative treatment was used in 245 (85.7%) patients. Mortality was not observed in 262 (91.6%) patients, 24 (8.4%) of the patients were died. HALP score was significantly higher in surviving patients (p=0.045). The median albumin value of the surviving patients was lower than that of the patients who died (p<0.001). The patients with mortality had significantly higher age, urea, creatinine, AST, and CRP values than those without (p=0.002, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.001, respectively). HALP score of patients with conservative treatment was significantly higher (p=0.003) than those who underwent surgical treatment. Lymphocyte value was significantly higher in patients followed up with conservative treatment (p=0.027). Age, urea, creatinine, and CRP scores were higher in patients who underwent surgery (p=0.007, p<0.001, 0.003, and p<0.001, respectively). HALP score demonstrated that sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio values for a HALP score of 28 were 50.6%, 78.0%, 2.3, and 0.63 for predicting conservative treatment (AUC 0.645 [95% confidence interval =0.556–0.735]; p=0.003). CONCLUSION: The HALP score is an important scoring system that may be useful in determining mortality and treatment modal-ity in patients with ileus. We believe that HALP score will contribute positively to the management of patients with a diagnosis of ileus, both in reducing mortality and in determining the appropriate treatment modality.