{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:06Z","timestamp":1787027286574,"version":"build-2736575974"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n The HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) score integrates key parameters reflecting nutritional and immune status. However, its prognostic value for in-hospital mortality in sepsis patients remains underexplored.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association between HALP score and in-hospital mortality in sepsis patients using two large critical care databases.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a retrospective cohort study including adult patients with Sepsis-3 from the eICU Collaborative Research Database (derivation cohort,\n n<\/jats:italic>\n = 12,899) and the MIMIC-IV database (validation cohort,\n n<\/jats:italic>\n = 3,726). HALP was calculated as (hemoglobin \u00d7 albumin \u00d7 lymphocyte count)\/platelet count, using first available values upon ICU admission. Restricted cubic spline (RCS) models assessed nonlinear relationships between HALP and mortality. Kaplan\u2013Meier survival curves and multivariable Cox regression models, adjusted for demographics, comorbidities, laboratory values, and Acute Physiology Score III, evaluated survival differences between low- and high-HALP groups. Segmented Cox regression examined associations below and above RCS-derived thresholds.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 16,625 patients were analyzed. RCS analysis demonstrated significant nonlinear associations between HALP and in-hospital mortality in both cohorts (overall\n P<\/jats:italic>\n &lt; 0.001; nonlinearity\n P<\/jats:italic>\n &lt; 0.001 in eICU,\n P<\/jats:italic>\n = 0.002 in MIMIC-IV), with an inflection point near 12.45. Below this threshold, each unit increase in HALP was associated with a 3% reduction in mortality risk (eICU: HR 0.97, 95% CI 0.95\u20130.99,\n P<\/jats:italic>\n = 0.002; MIMIC-IV: HR 0.97, 95% CI 0.94\u20130.99,\n P<\/jats:italic>\n = 0.008). Kaplan\u2013Meier analyses showed significantly higher survival in the high HALP group (eICU: log-rank\n P<\/jats:italic>\n = 0.005, HR 0.882, 95% CI 0.808\u20130.962; MIMIC-IV: log-rank\n P<\/jats:italic>\n &lt; 0.001, HR 0.723, 95% CI 0.607\u20130.862). Multivariable Cox regression confirmed that high HALP remained independently protective after full adjustment (eICU: HR 0.90, 95% CI 0.82\u20130.98,\n P<\/jats:italic>\n = 0.017; MIMIC-IV: HR 0.85, 95% CI 0.74\u20130.98,\n P<\/jats:italic>\n = 0.028).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The HALP score demonstrates robust prognostic value for predicting in-hospital mortality in sepsis patients, with consistent nonlinear relationships validated across two large databases. Its simplicity and reliance on routine laboratory parameters support potential clinical application in sepsis risk stratification.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1710118","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T05:45:29Z","timestamp":1768196729000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between HALP score and in-hospital mortality in sepsis patients: a multicenter retrospective cohort study with external validation"],"prefix":"10.3389","volume":"13","author":[{"given":"Xingping","family":"Lv","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yezhou","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuo","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qimin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaolin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"sepsis incidence and mortality 1990-2017: 1990-2017: analysis for the Global Burden of Disease Study","volume":"395","year":"2020","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.1007\/s00134-018-5377-4","article-title":"Challenges in assessing the burden of sepsis and understanding the inequalities of sepsis outcomes between National Health Systems: secular trends in sepsis and infection incidence and mortality in Germany","volume":"44","author":"Fleischmann-Struzek","year":"2018","journal-title":"Intensive Care Med."},{"key":"B3","unstructured":"Sepsis\n \n \n \n 2024"},{"key":"B4","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1016\/S0140-6736(12)61815-7","article-title":"Sepsis definitions: time for change","volume":"381","author":"Vincent","year":"2013","journal-title":"Lancet."},{"key":"B5","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II a severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit Care Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. 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