The association between hemoglobin-albumin-lymphocyte-platelet(HALP)score,pan-immune inflammatory value,and postoperative cognitive impairment in aneurysmal subarachnoid hemorrhage patients
BAI Jiang
DUAN Gaowei
SONG Zhibin
MA Tengfei
JI Wengan
Abstract：Objective To investigate the relationship between the hemoglobin-albumin-lymphocyte-platelet(HALP)score,pan-immune inflammatory value(PIV),and postoperative cognitive dysfunction(POCD)in patients with aneurysmal subarachnoid hemorrhage(aSAH),and to construct a predictive model.Methods The data of 235 aSAH patients who underwent interventional embolization were retrospectively analyzed.The patients were randomly divided into a training set(165 patients)and a validation set(70 patients)at a 7:3 ratio.Based on the occurrence of POCD at 6 months postoperatively,aSAH patients were divided into a POCD group and a non-POCD group.The HALP score and PIV were calculated.Multivariate logistic regression was applied to identify risk factors of POCD in aSAH patients and construct a nomogram prediction model.The Hosmer-Lemeshow(H-L)test assessed goodness-of-fit,the receiver operating characteristic(ROC)curve evaluated the predictive performance,the concordance index(C-index)evaluated discriminatory ability,the calibration curve evaluated accuracy,and decision curve analysis(DCA)assessed clinical benefit.Results The incidence of POCD was 43.03%(71/165)in the training set and 40.00%(28/70)in the validation set.Hypertension(OR=4.491,95%CI:1.605-12.564,P=0.004),Hunt-Hess grade Ⅲ～Ⅳ(OR=3.274,95%CI:1.252-8.559,P=0.016),modified Fisher grade Ⅲ～Ⅳ(OR=3.140,95%CI:1.239-7.962,P=0.016),and an increased PIV(OR=1.011,95%CI:1.006-1.015,P<0.001)increased the risk of POCD in aSAH patients,while a higher HALP score(OR=0.923,95%CI:0.888-0.960,P<0.001)reduced this risk.A nomogram predictive model for POCD in aSAH patients was established based on the HALP score and PIV[Logit(P)=-0.912+1.502×hypertension+1.186×Hunt-Hess grade+1.144×modified Fisher grade-0.080×HALP+0.011×PIV].The H-L testχ²=5.819,P=0.668.Internal and external validations were performed on the training and validation sets,respectively.The area under the curve(AUC)for predicting POCD in aSAH patients by the nomogram predictive model in the training set and the validation set was 0.912 and 0.888,respectively,both of which were greater than those predicted by hypertension,Hunt-Hess grade,modified Fisher grade,HALP score,and PIV alone(all P<0.05).After 1,000 bootstrap resampling validations,the C-indices were 0.912 and 0.872,respectively.The calibration curve of the nomogram predictive model closely matched the actual curve.The nomogram predictive model provided a positive net benefit within the threshold probability range of 0.05-1.0 in the training set and 0.15-1.0 in the validation set.Conclusions A decreased HALP score and an increased PIV are significant risk factors for the occurrence of POCD in aSAH patients.The nomogram predictive model constructed based on these factors has high predictive performance for the occurrence of POCD in aSAH patients.
Keywords：subarachnoid hemorrhageaneurysmalhemoglobin-albumin-lymphocyte-platelet scorepan-immune-inflammation valuecognitive dysfunction
Publication Date：2026-02-20
Online Publishing Date：2026-03-18(First online date of this platform, not the publication date of the document)
Pages：8( 88-95 )