The HALP (hemoglobin, Albumin, Lymphocyte, and Platelet) Score is Associated with Hemorrhagic Transformation After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

Overview

Journal Front Neurol

Specialty Neurology

Date 2024 Nov 11

PMID 39524911

Authors

Jiahao Chen

Rui Hu

Lejia Shang

Xiaoqin Li

Yisi Lin

Yu Yao

Chuanchen Hu

Affiliations

Soon will be listed here.

Abstract

Background: Hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) with rt-PA can precipitate rapid neurological deterioration, poor prognosis, and even death. The HALP score (hemoglobin, albumin, lymphocyte, and platelet) is a novel indicator developed to reflect both systemic inflammation and the nutritional status of patients. The goal of this study was to reveal the relationship between the HALP score and the risk of HT after IVT in people with acute ischemic stroke (AIS).

Methods: A total of 753 patients with AIS were included in this study. Patients were divided into quartiles according to baseline HALP score. The HALP score was calculated as follows: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Binary logistic regression was used to reveal the connection between HALP score and HT.

Results: The baseline HALP score were significantly lower in the HT than non-HT patients ( < 0.001). The HALP score were divided into four quartiles: Q1 (<27.4), Q2 (27.4-37.6), Q3 (37.7-49.6), Q4 (>49.6), respectively. Moreover, the severity of HT increased with decreasing HALP level ( < 0.001). In multivariable logistic regression, taking the Q4 as the reference, the association between Q1 and HT remained, after adjusting for confounding variables [odds ratio (OR) = 3.197, 95% confidence interval (CI) = 1.634-6.635, = 0.003].

Conclusion: The HALP value can predict the HT risk after IVT in patients with AIS. A lower HALP level was associated with an increased severity of HT post-IVT.

References

Narasimhalu K, Lee J, Leong Y, Ma L, De Silva D, Wong M . Inflammatory markers and their association with post stroke cognitive decline. Int J Stroke. 2013; 10(4):513-8. DOI: 10.1111/ijs.12001. View

He J, Fu F, Zhang W, Zhan Z, Cheng Z . Prognostic significance of the clinical and radiological haemorrhagic transformation subtypes in acute ischaemic stroke: A systematic review and meta-analysis. Eur J Neurol. 2022; 29(11):3449-3459. DOI: 10.1111/ene.15482. View

Diestro J, Parra-Farinas C, Balas M, Zador Z, Almusalam N, Dmytriw A . Inflammatory Biomarkers and Intracranial Hemorrhage after Endovascular Thrombectomy. Can J Neurol Sci. 2021; 49(5):644-650. DOI: 10.1017/cjn.2021.197. View

Cheng Z, Zhan Z, Huang X, Xia L, Xu T, Han Z . Troponin Elevation on Admission Along With Dynamic Changes and Their Association With Hemorrhagic Transformation After Thrombolysis. Front Aging Neurosci. 2021; 13:758678. PMC: 8548361. DOI: 10.3389/fnagi.2021.758678. View

Vogelgesang A, Grunwald U, Langner S, Jack R, Broker B, Kessler C . Analysis of lymphocyte subsets in patients with stroke and their influence on infection after stroke. Stroke. 2007; 39(1):237-41. DOI: 10.1161/STROKEAHA.107.493635. View

Chen R, Jiang G, Liu Y, Pan H, Yan L, Zhao L . Predictive effects of S100β and CRP levels on hemorrhagic transformation in patients with AIS after intravenous thrombolysis: A concise review based on our center experience. Medicine (Baltimore). 2023; 102(38):e35149. PMC: 10519468. DOI: 10.1097/MD.0000000000035149. View

Jickling G, Liu D, Stamova B, Ander B, Zhan X, Lu A . Hemorrhagic transformation after ischemic stroke in animals and humans. J Cereb Blood Flow Metab. 2013; 34(2):185-99. PMC: 3915212. DOI: 10.1038/jcbfm.2013.203. View

Yang M, Zhong W, Zou W, Peng J, Tang X . A novel nomogram to predict hemorrhagic transformation in ischemic stroke patients after intravenous thrombolysis. Front Neurol. 2022; 13:913442. PMC: 9494598. DOI: 10.3389/fneur.2022.913442. View

Zhang G, Pan Y, Zhang R, Wang M, Meng X, Li Z . Prevalence and Prognostic Significance of Malnutrition Risk in Patients With Acute Ischemic Stroke: Results From the Third China National Stroke Registry. Stroke. 2021; 53(1):111-119. DOI: 10.1161/STROKEAHA.121.034366. View

10.

Yang M, Tang L, Bing S, Tang X . Association between fibrinogen-to-albumin ratio and hemorrhagic transformation after intravenous thrombolysis in ischemic stroke patients. Neurol Sci. 2022; 44(4):1281-1288. DOI: 10.1007/s10072-022-06544-4. View

11.

Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R . Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995; 274(13):1017-25. View

12.

Berge E, Whiteley W, Audebert H, De Marchis G, Fonseca A, Padiglioni C . European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021; 6(1):I-LXII. PMC: 7995316. DOI: 10.1177/2396987321989865. View

13.

Xu Y, Li X, Wu D, Zhang Z, Jiang A . Machine Learning-Based Model for Prediction of Hemorrhage Transformation in Acute Ischemic Stroke After Alteplase. Front Neurol. 2022; 13:897903. PMC: 9226411. DOI: 10.3389/fneur.2022.897903. View

14.

Yaghi S, Willey J, Cucchiara B, Goldstein J, Gonzales N, Khatri P . Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017; 48(12):e343-e361. DOI: 10.1161/STR.0000000000000152. View

15.

Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J . Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front Neurol. 2021; 12:661955. PMC: 8160112. DOI: 10.3389/fneur.2021.661955. View

16.

Lam F, Cruz M, Leung H, Parikh K, Smith C, Rumbaut R . Histone induced platelet aggregation is inhibited by normal albumin. Thromb Res. 2013; 132(1):69-76. DOI: 10.1016/j.thromres.2013.04.018. View

17.

Chen X, Xue L, Wang W, Chen H, Zhang W, Liu K . Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015; 6(38):41370-82. PMC: 4747412. DOI: 10.18632/oncotarget.5629. View

18.

Taverna M, Marie A, Mira J, Guidet B . Specific antioxidant properties of human serum albumin. Ann Intensive Care. 2013; 3(1):4. PMC: 3577569. DOI: 10.1186/2110-5820-3-4. View

19.

Yang Y, Xie D, Zhang Y . Increased Platelet-to-Lymphocyte Ratio is an Independent Predictor of Hemorrhagic Transformation and In-Hospital Mortality Among Acute Ischemic Stroke with Large-Artery Atherosclerosis Patients. Int J Gen Med. 2021; 14:7545-7555. PMC: 8570380. DOI: 10.2147/IJGM.S329398. View

20.

Prass K, Meisel C, Hoflich C, Braun J, Halle E, Wolf T . Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation. J Exp Med. 2003; 198(5):725-36. PMC: 2194193. DOI: 10.1084/jem.20021098. View