Diagnostic and predictive value of the hemoglobin-albumin-lymphocyte-platelet score in thyroid nodules: A retrospective analysis of 521 patients

Objectives: The hemoglobin-albumin-lymphocyte-platelet (HALP) score, an integrated immunonutritional index, has shown significant prognostic value in several aggressive solid tumors. However, its role in the diagnostic workup and predictive stratification of thyroid cancer remains underexplored. This study aimed to comprehensively evaluate the diagnostic efficacy of the pre-operative HALP score and its association with lymph node metastasis (LNM) in patients undergoing thyroidectomy.
Methods: We retrospectively reviewed 521 consecutive patients who underwent thyroid surgery between 2022 and 2024. Pre-operative laboratory parameters, including thyroid-stimulating hormone (TSH), fT4, albumin, and complete blood count, were recorded. The HALP score was calculated as (Hemoglobin×Albumin×Lymphocytes)/Platelets. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis ROC in combination with multivariate logistic regression. A subgroup analysis was performed for malignant cases to evaluate predictors of LNM.
Results: Of the cohort, 210 (40.3%) patients had malignant pathology. While serum TSH (p<0.001) and fT4 (p=0.043) were significantly higher in the malignant group, the HALP score demonstrated no significant difference (50.8±17.9 vs. 51.2±18.4, p=0.694). ROC analysis yielded an area under the curve of 0.510 for the HALP score, indicating a lack of discriminative power. In multivariate analysis, only Bethesda categories V (odds ratio [OR]: 17.48) and VI (OR: 104.29) were independent predictors of malignancy. For LNM, younger age (p=0.005), higher TSH (p=0.036), and lymphovascular invasion (p<0.001) were significant predictors, whereas the HALP score showed no predictive value (p=0.919). Conclusion: The pre-operative HALP score does not serve as a reliable diagnostic or predictive biomarker for thyroid malignancy or LNM. Pre-operative stratification should remain focused on cytopathology and established clinical-ultrasonographic risk factors.

Keywords: Biomarkers, Hemoglobin-albumin-lymphocyte-platelet score, Inflammation markers, Lymph node metastasis, Thyroid cancer, Thyroid nodule