Predictive value of the HALP score in differentiating complicated and uncomplicated acute appendicitis

BACKGROUND: Acute appendicitis is one of the most common causes of emergency abdominal surgery, and early identification of complicated cases is critical for effective clinical management. Although classical inflammatory markers such as white blood cell count (WBC), C-reactive protein (CRP), and immature granulocyte percentage (IG%) are commonly used in diagnosis, their predictive accuracy remains limited. The HALP score (hemoglobin, albumin, lymphocyte, and platelet score), which incorporates hemoglobin, albumin, lymphocyte, and platelet levels, may offer a more comprehensive assessment by reflecting both inflammatory and immunonutritional status. METHODS: This retrospective study included 854 patients who underwent appendectomy between January 2022 and December 2023 at a tertiary care center. Based on surgical and pathological findings, patients were categorized into two groups: complicated and uncomplicated appendicitis. Demographic data, along with hemoglobin, albumin, lymphocyte, platelet, WBC, CRP, and IG% values, were recorded. The diagnostic performance of these parameters was statistically evaluated. RESULTS: Among the 854 patients, 112 (13.1%) were diagnosed with complicated appendicitis. Complicated cases showed a significantly higher median age and a predominance of female patients. CRP, WBC, IG%, and platelet levels were significantly elevated in the complicated group, while hemoglobin, albumin, and lymphocyte counts were lower. The HALP score was significantly lower in patients with complicated appendicitis compared to those with uncomplicated appendicitis (median: 32.8 vs. 53.4, p<0.001). Among the evaluated markers, the HALP score demonstrated the highest diagnostic performance (area under the curve [AUC]: 0.732), followed by CRP (AUC: 0.706), IG% (AUC: 0.645), and WBC (AUC: 0.574). CONCLUSION: The HALP score is a valuable and easily applicable biomarker for predicting complicated acute appendicitis. It outperforms traditional inflammatory markers by incorporating parameters that reflect both systemic inflammation and immuno-nutritional status. Routine use of the HALP score in emergency surgical evaluations may facilitate early identification of high-risk patients and guide clinical decision-making. Prospective, multicenter studies are needed to further validate its clinical utility.