Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study

Abstract

Objective

The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation and nutritional status that has not been correlated with the risk of post-stroke cognitive impairment in patients with acute ischemic stroke or transient ischemic attack (TIA).

Methods

Study participants were recruited from 40 stroke centers in China. The HALP score was derived using a weighted sum of hemoglobin, albumin, lymphocytes and platelets, and study participants were categorized into 4 groups of equal sizes based on quartiles cutoffs of the HALP score. The Montreal Cognitive Assessment (MoCA)-Beijing Cognitive Assessment Scale (MoCA-Beijing) was performed at 2 weeks and 12 months following stroke onset. Post-stroke cognitive impairment was considered in patients with MoCA-Beijing≤22. Multiple logistic regression methods were employed to evaluate the relationship between the HALP score and the subsequent risk of developing post-stroke cognitive impairment.

Results

The study population comprised 1022 patients (mean age 61.6±11.0 years, 73% men). The proportion of individuals with MoCA-Beijing≤22 at 2 weeks was 49.2% and 32.4% at one year. Patients in the lowest quartile of HALP score (<36.56) were observed to harbor the highest risk of post-stroke cognitive impairment at 12 months post-stroke/TIA compared to those in the highest quartile (odds ratio=1.59, 95% CI=1.07–2.37, p=0.022), and lower domain scores for executive function, naming, and attention. There were no statistically significant differences between patients in the different quartiles of HALP score and HALP score at 2 weeks post-stroke/TIA.

Conclusion

The HALP score is a simple score that could stratify the risk of post-stroke cognitive impairment in stroke/TIA patients to facilitate early diagnosis and interventions.

Keywords:

• mild stroke
• post stroke cognitive impairment
• hemoglobin
• albumin
• lymphocyte
• platelet

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

Ethical Approval

This study involves human participants and was approved by the Ethics Committee of all participating hospitals (Appendix S1) in accordance with the Declaration of Helsinki, and the IRB approval number is KY2015-001-01.

Informed Consent

Prior to data collection, all participants or their legal representatives signed written informed consents.

Acknowledgments

The authors would like to thank all participants for their involvement.

Disclosure

The authors declare that they have no conflict of interest.

Additional information

Funding

This work was supported by the following institutions: The Capital’s Funds for Health Improvement and Research (2020-1-2041), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2019-I2M-5-029), Capital Medical University Cultivation Fund (PYZ22120). The National Key Research and Development Program of China (2022YFC2504902 and 2020YFC2004800) and Beijing Excellent Talents Training Program (2018000021469G237). Y. Dong is supported by the Singapore National Medical Research Council (NMRC) Transition Award [NMRC/TA/0060/2017].