Letter: Prognostic Value of HALP Score in Predicting Contrast-Induced Acute Kidney Injury in Elderly STEMI Patients

We read with great interest the recent study by Kalcik et al ¹ titled “Prognostic Value of HALP Score in Predicting Contrast-Induced Acute Kidney Injury in Elderly STEMI Patients.” The authors present a compelling retrospective analysis demonstrating that the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score serves as an independent predictor of contrast-induced acute kidney injury (CI-AKI) in elderly patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). This work is a valuable contribution to the ongoing effort to improve risk stratification for this serious complication.

The finding that a lower HALP score (cut-off <2.7) is significantly associated with CI-AKI development, with an area under the curve of 0.698, underscores the critical interplay between nutritional status, systemic inflammation, and renal vulnerability. The study rightly highlights how components of the HALP score—such as hypoalbuminemia, anemia, and lymphopenia—reflect pathways like endothelial dysfunction, oxidative stress, and impaired immunomodulation that are implicated in CI-AKI pathogenesis. This aligns with growing evidence linking malnutrition-inflammation complex syndrome to adverse outcomes in cardiovascular and renal diseases, as also observed in other studies investigating HALP in cardiovascular contexts.^2,3

We agree with the authors that the HALP score’s major advantage lies in its simplicity and ready derivation from routine admission blood tests, making it a practical tool for bedside risk assessment. ⁴ In an era of increasingly complex risk models, such accessible biomarkers are crucial for timely identification of high-risk patients, potentially guiding preventive measures like stringent contrast minimization and optimized hydration protocols. ⁵

However, as noted in the manuscript’s limitations, future prospective and multi-center studies are needed to validate these findings and to compare the HALP score against other established biomarkers (e.g., cystatin C, neutrophil gelatinase-associated lipocalin) and integrated risk scores. ⁶ Furthermore, investigating whether interventions aimed at improving nutritional and inflammatory status can modify CI-AKI risk in patients with low HALP scores would be a logical and impactful next step.

In conclusion, Kalcik et al have provided important evidence supporting the integration of the HALP score into the risk assessment toolkit for elderly STEMI patients. This study paves the way for further research into personalized, pathophysiology-based prevention strategies for CI-AKI.