Association Between Hemoglobin-Albumin-Lymphocyte-Platelet Index and Mortality in Hospitalized COVID-19 Omicron BA.2 Infected Patients

Abstract

Background

The hemoglobin-albumin-lymphocyte-platelet (HALP) index is a novel biomarker reflecting systemic inflammation and nutritional status which are important for coronavirus disease 2019 (COVID-19) mortality. However, the association between HALP and mortality in patients with COVID-19 has yet to be investigated.

Methods

A cohort of COVID-19 Omicron BA.2 infected patients admitted to the Shanghai Fourth People’s Hospital, School of Medicine, Tongji University from April 12, 2022 to June 17, 2022 was retrospectively analyzed. Laboratory examinations on hospital admission, including hemoglobin, albumin, and lymphocyte and platelet, were collected. The association between baseline HALP and in-hospital poor overall survival (OS) was assessed using Kaplan–Meier curves, Cox regression models, interaction, and stratified analyses.

Results

A total of 2147 patients with COVID-19 Omicron BA.2 infection were included in the final analyses, and mortality in the hospital was 2.65%. Multivariate analysis indicated that low HALP index was independently associated with in-hospital mortality of COVID-19 patients [hazard ratio (HR) = 2.08; 95% confidence interval (CI) = 1.17–3.73]. Subgroup analysis demonstrated that low HALP index was an independent risk factor for in-hospital mortality in COVID-19 patients with age ≥70 (HR = 2.22, CI = 1.18–4.15) and severe cases (HR = 2.09, CI = 1.13–3.86).

Conclusion

HALP index is independently related to in-hospital poor OS for COVID-19 Omicron BA.2 infected patients, especially for age ≥70 and severe cases. HALP index on hospital admission is a useful candidate biomarker for identifying high risk of mortality in COVID-19 Omicron BA.2 infected patients.

Keywords:

• biomarkers
• COVID-19
• hemoglobin-albumin-lymphocyte-platelet index
• mortality
• Omicron BA.2

Data Sharing Statement

The data supporting the findings of this study can be obtained from the corresponding author (Xiya Yu) according to reasonable request, and the corresponding author/s can be directly contacted for further inquiry.

Ethics Statement

The study concerning human participants was reviewed and approved by the ethics committee at Shanghai Fourth People’s Hospital. The requirement for informed consent was waived by the ethics committee. The study project conforms to the ethical guidelines of the Declaration of Helsinki. In order to publish any potentially identifiable images or data contained in this article, written informed consent was obtained from the individual(s).

Acknowledgments

We thank all those who supported and participated in the study, including our staff, patients, and their family members.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors state that the study was conducted without any commercial or financial relationships and potential conflicts of interest.

Additional information

Funding

This work was supported by the Major Program of National Natural Science Foundation of China (82293640 and 82293643), the Research Initiation Foundation of Shanghai Fourth People’s Hospital (sykyqd05901), the Discipline Boosting Program of Shanghai Fourth People’s Hospital (SY-XKZT-2022-1003), and the Innovative Program of First Affiliated Hospital of Naval Medical University (2020YXK013).