{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:31:06Z","timestamp":1783567866857,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The hemoglobin\u2013albumin\u2013lymphocyte\u2013platelet (HALP) score integrates the immunonutritional and inflammatory status. We evaluated whether baseline HALP predicts the 3-month response after lumbar medial branch radiofrequency ablation (RFA), defined as a Visual Analogue Scale (VAS) reduction of \u226550% and an Oswestry Disability Index (ODI) reduction of \u226540%, and identified a Youden-optimal cut-off. The discrimination and calibration of multivariable models were also assessed. Methods: This single-center retrospective cohort (N = 120) included rigorously selected patients (\u226550% pain relief after two comparative medial branch blocks) undergoing standardized RFA. Multivariable logistic regression was adjusted for age, sex, Body Mass Index (BMI), smoking status, paraspinal tenderness, and baseline scores. We quantified the Area Under the Receiver Operating Characteristic Curve (AUC), Hosmer\u2013Lemeshow (HL) goodness-of-fit, Brier score, and calibration slope; optimism was corrected using a 500-bootstrap method. Results: Responses occurred in 64.2% (VAS) and 65.8% (ODI) of participants. HALP independently predicted ODI (OR = 1.06, 95% CI 1.02\u20131.09; p &lt; 0.001) and VAS (OR = 1.05, 95% CI 1.02\u20131.08; p = 0.001). As a single predictor, HALP showed fair discrimination (AUC 0.717 [VAS], 0.731 [ODI]). The Youden cut-off of 39.8 yielded high sensitivity (~0.87) with modest specificity (~0.58\u20130.61). Multivariable AUCs were 0.744 (VAS) and 0.774 (ODI), optimism-corrected to 0.680 and 0.720; calibration was acceptable (HL p &gt; 0.05; slopes \u2248 0.74\u20130.78; Brier 0.188\/0.179). Conclusions: HALP is a simple, low-cost adjunct that independently predicts short-term pain and functional outcomes after lumbar medial branch RFA. Incorporation into post-block triage may refine selection, especially for functional improvement, pending prospective external validation and recalibration of the cut-off.<\/jats:p>","DOI":"10.3390\/diagnostics15212758","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:55:22Z","timestamp":1762178122000},"page":"2758","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of the Hemoglobin\u2013Albumin\u2013Lymphocyte\u2013Platelet (HALP) Score with 3-Month Outcomes After Lumbar Medial Branch Radiofrequency Ablation: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1740-8339","authenticated-orcid":false,"given":"\u00c7ile","family":"Aktan","sequence":"first","affiliation":[{"name":"Department of Pain Medicine, Antalya Training and Research Hospital, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1841-6023","authenticated-orcid":false,"given":"G\u00f6zde","family":"\u00c7elik","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Malatya Training and Research Hospital, 44000 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8245-2187","authenticated-orcid":false,"given":"Cemil","family":"Aktan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3344\/kjp.23228","article-title":"Facet joint disorders: From diagnosis to treatment","volume":"37","author":"Yoo","year":"2024","journal-title":"Korean J. Pain"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Assavanop, S., Alomari, A., and Bhatia, A. (2024). Diagnostic block(s) before radiofrequency ablation of innervation to the spinal facet joints: None, once or two times\u2014An international survey of pain medicine physicians. Reg. Anesth. Pain Med., epub ahead of print.","DOI":"10.1136\/rapm-2024-105726"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/ALN.0000000000002130","article-title":"Neuroinflammation and Central Sensitization in Chronic and Widespread Pain","volume":"129","author":"Ji","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1186\/s40001-024-02211-w","article-title":"Impact of hematologic inflammatory markers on the prognosis of geriatric hip fracture:A systematic review and meta-analysis","volume":"29","author":"Pan","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"105705","DOI":"10.1016\/j.intimp.2019.105705","article-title":"Predictive value of post-operative neutrophil\/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery","volume":"74","author":"Shen","year":"2019","journal-title":"Int. Immunopharmacol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"dju124","DOI":"10.1093\/jnci\/dju124","article-title":"Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis","volume":"106","author":"Templeton","year":"2014","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bizzarri, F.P., Campetella, M., Russo, P., Palermo, G., Moosavi, S.K., Rossi, F., D\u2019Amico, L., Cret\u00ec, A., Gavi, F., and Panio, E. (2025). Prognostic Value of PLR, SIRI, PIV, SII, and NLR in Non-Muscle Invasive Bladder Cancer: Can Inflammatory Factors Influence Pathogenesis and Outcomes?. Cancers, 17.","DOI":"10.3390\/cancers17132189"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"109496","DOI":"10.1016\/j.intimp.2022.109496","article-title":"Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients","volume":"114","author":"Xu","year":"2023","journal-title":"Int. Immunopharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4133","DOI":"10.1007\/s00277-025-06272-7","article-title":"The prognostic value of hemoglobin, albumin, lymphocyte, and platelet (HALP) score in low-risk and early-stage extranodal natural killer\/T cell lymphoma","volume":"104","author":"Li","year":"2025","journal-title":"Ann. Hematol."},{"key":"ref_10","first-page":"33","article-title":"The Role of Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) Score in Acute Pancreatitis\u2014An Analytical Study","volume":"14","author":"Duman","year":"2024","journal-title":"VHS"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jor.2020.03.058","article-title":"Anatomy and pathology of facet joint","volume":"22","author":"Almeer","year":"2020","journal-title":"J. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1097\/BRS.0b013e318184ef95","article-title":"Facet joint osteoarthritis and low back pain in the community-based population","volume":"33","author":"Kalichman","year":"2008","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1146\/annurev-bioeng-062117-120924","article-title":"Facet Joints of the Spine: Structure-Function Relationships, Problems and Treatments, and the Potential for Regeneration","volume":"20","author":"Paschos","year":"2018","journal-title":"Annu. Rev. Biomed. Eng."},{"key":"ref_14","unstructured":"Cascio, M.A., Dua, A., and Varacallo, M.A. (2025). Lumbosacral Facet Syndrome. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"385","DOI":"10.4055\/cios.2014.6.4.385","article-title":"The prevalence of lumbar spine facet joint osteoarthritis and its association with low back pain in selected Korean populations","volume":"6","author":"Ko","year":"2014","journal-title":"Clin. Orthop. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"308","DOI":"10.36076\/ppj.2001\/4\/308","article-title":"Evaluation of the relative contributions of various structures in chronic low back pain","volume":"4","author":"Manchikanti","year":"2001","journal-title":"Pain Physician"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3689","DOI":"10.2147\/JPR.S389602","article-title":"Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment","volume":"15","author":"Du","year":"2022","journal-title":"J. Pain Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s00586-007-0391-1","article-title":"Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain","volume":"16","author":"Hancock","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E869","DOI":"10.36076\/ppj.2012\/15\/E869","article-title":"An update of the systematic assessment of the diagnostic accuracy of lumbar facet joint nerve blocks","volume":"15","author":"Falco","year":"2012","journal-title":"Pain Physician"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/AAP.0000000000000229","article-title":"Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation: A Multicenter, Case-Control Study","volume":"40","author":"Cohen","year":"2015","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/01.ajp.0000210941.04182.ea","article-title":"Clinical predictors of success and failure for lumbar facet radiofrequency denervation","volume":"23","author":"Cohen","year":"2007","journal-title":"Clin. J. Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1097\/BRS.0000000000004776","article-title":"Predictors of Outcomes After Lumbar Intra-Articular Facet Joint Injections and Medial Branch Blocks: A Scoping Review","volume":"48","author":"Mandell","year":"2023","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/2049463719840053","article-title":"Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique","volume":"14","author":"Eldabe","year":"2020","journal-title":"Br. J. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s40122-023-00512-2","article-title":"Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome","volume":"12","author":"Occhigrossi","year":"2023","journal-title":"Pain Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/papr.13287","article-title":"3. Pain originating from the lumbar facet joints","volume":"24","author":"Cohen","year":"2024","journal-title":"Pain Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1097\/01.brs.0000141265.55411.30","article-title":"Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders","volume":"29","author":"Igarashi","year":"2004","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/nyas.13551","article-title":"Inflammatory biomarkers of low back pain and disc degeneration: a review","volume":"1410","author":"Khan","year":"2017","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.2147\/JPR.S198359","article-title":"A single session of hyperbaric oxygen therapy demonstrates acute and long-lasting neuroplasticity effects in humans: A replicated, randomized controlled clinical trial","volume":"12","author":"Wahl","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Xin, Y., Wang, Y., Shu, Y., Liang, H., and Yang, Y. (2025). Hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict prognosis in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-04968-2"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"674","DOI":"10.14444\/8290","article-title":"Does Preoperative Neutrophil-Lymphocyte Ratio Predict Patient-Reported Pain and Functional Outcomes at 12 Months After Lumbar Fusion?","volume":"16","author":"Osunronbi","year":"2022","journal-title":"Int. J. Spine Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4192","DOI":"10.1007\/s00586-023-07913-z","article-title":"The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels following erector spinae plane block (ESPB) in posterior lumbar decompression: a randomized, controlled trial","volume":"32","author":"Domagalska","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Zhao, X., Zhang, J., Li, J., Cao, K., and Wu, J. (2025). The predictive value of neutrophil-to-lymphocyte ratio in the efficacy of percutaneous lumbar disc radiofrequency ablation for lumbar disc herniation. Front. Pain Res., 6.","DOI":"10.3389\/fpain.2025.1543317"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/21\/2758\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T14:05:40Z","timestamp":1762178740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/21\/2758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":32,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["diagnostics15212758"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15212758","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}