HALP评分及改良HALP评分对ICU脓毒性休克患者28天生存预测分析

Analysis of HALP Score and Modified HALP Score for Predicting 28-Day Survival in ICU Patients with Septic Shock

摘要: 目的：评估和比较血红蛋白–白蛋白–淋巴细胞–血小板(Hemoglobin, Albumin, Lymphocyte and Platelet, HALP)评分与改良HALP (modified HALP, mHALP)评分对ICU脓毒性休克患者28天生存率的预测能力。方法：研究对2022年8月至2024年8月在济宁市第一人民医院ICU确诊为脓毒症休克的328例患者进行回顾性分析。收集患者的一般资料、实验室数据及各类评分，28天生存情况作为结局指标。通过单因素和多因素Logistic回归分析筛选生存的独立预测因素，并用ROC曲线比较两种评分的预测效果，同时绘制Kaplan-Meier曲线分析不同mHALP分组的生存差异。结果：328例患者中，178例在28天内死亡，150例存活超过28天，生存率为45.7%。生存组的白蛋白、淋巴细胞计数、血小板计数、HALP评分和mHALP评分显著高于死亡组，死亡组的APACHE II评分、SOFA评分、降钙素、乳酸和C反应蛋白明显高于生存组，差异具有统计学意义(P < 0.001)。Logistic回归分析显示，mHALP评分升高(OR: 1.018)与28天生存率增加相关，乳酸(OR: 0.7)、APACHE II评分(OR: 0.905)及SOFA评分(OR: 0.792)升高则降低生存率。mHALP评分对28天生存率的AUC为0.852，敏感性为0.698，特异性为0.827，最佳截断值为270473.69。根据此值分组，两组生存时间分布差异具有统计学意义(χ² = 74.44，P < 0.001)。结论：mHALP评分对ICU脓毒性休克患者28天生存率的预测效果优于传统的HALP评分，适合用于临床预后评估。

Abstract: Objective: To assess and compare the predictive ability of the hemoglobin, albumin, lymphocyte, platelet (HALP) score with the modified HALP (mHALP) score for 28-day survival in patients with septic shock in the ICU. Methods: The study retrospectively analyzed 328 patients diagnosed with septic shock from August 2022 to August 2024 in the ICU of the First People’s Hospital of Jining City. General data, laboratory data and various scores of patients were collected, and 28-day survival was used as an outcome indicator. Independent predictors of survival were screened by univariate and multivariate logistic regression analyses, and ROC curves were used to compare the predictive effects of the two scores, while Kaplan-Meier curves were plotted to analyze the differences in survival between different mHALP subgroups. Results: Of the 328 patients, 178 died within 28 days and 150 survived more than 28 days, resulting in a survival rate of 45.7%. Albumin, lymphocyte count, platelet count, HALP score, and mHALP score were significantly higher in the survival group than in the death group, and APACHE II score, SOFA score, calcitonin, lactate, and C-reactive protein were significantly higher in the death group than in the survival group, with statistically significant differences (P < 0.001). logistic regression analysis showed that an elevated mHALP score (OR: 1.018) was associated with increased 28-day survival, while elevated lactate (OR: 0.7), APACHE II score (OR: 0.905), and SOFA score (OR: 0.792) decreased survival. mHALP score had an AUC of 0.852, a sensitivity of 0.698, a specificity of 0.827, and an optimal cutoff value of 28-day survival of 270473.69. grouped according to this value, the difference in the distribution of survival times between the two groups was statistically significant (χ² = 74.44, P < 0.001). Conclusion: The mHALP score is better than the traditional HALP score in predicting 28-day survival in ICU septic shock patients and is suitable for clinical prognostic assessment.