Prognostic Role of HALP Score, CALLY Index, and Prognostic Nutritional Index in Polytrauma Patients Followed in the Intensive Care Unit: A Retrospective Cohort Study
In a retrospective cohort study of 162 ICU polytrauma patients, the Prognostic Nutritional Index (PNI) was identified as the only independent predictor of in-hospital mortality among the evaluated immunological and nutritional scores, outperforming both the CALLY index and HALP score.
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When a person suffers severe injuries to multiple parts of the body, doctors face a race against time to predict who will survive and who might not. This is the world of polytrauma, a condition where the damage is so extensive that it triggers a complex chain reaction inside the body. The body's natural defenses, which usually fight off infection and heal wounds, can sometimes go into overdrive or shut down completely, leading to a dangerous mix of inflammation and a weakened immune system. At the same time, the body burns through its energy reserves at a frantic pace. For decades, medical teams have relied on scores based on the location and severity of physical injuries to make these predictions. However, researchers are increasingly looking for clues in the blood itself, hoping to find simple markers that reveal how well a patient's body is holding up against the stress of the crash.
A team of researchers at a hospital in Istanbul set out to test three specific blood-based scores that combine information about nutrition, inflammation, and immune health. They focused on patients admitted to the intensive care unit with severe, multi-system injuries. The goal was to see if these scores could predict death better than the standard injury assessments used today. The three tools they examined were the Prognostic Nutritional Index, which looks at protein levels and white blood cell counts; the CALLY index, which adds a measure of inflammation to that mix; and the HALP score, which also includes red blood cell and platelet counts. These are not new inventions, but their ability to forecast outcomes in the specific, chaotic environment of a trauma intensive care unit had not been thoroughly compared before.
The study looked back at the medical records of 162 adult patients treated between 2021 and 2023. All of them had been admitted to the intensive care unit within a day of their injury and met the strict medical definition of polytrauma. The researchers carefully gathered data from the moment each patient arrived, recording their age, the type of accident, and their initial physical condition. They also pulled the very first blood test results available to calculate the three scores in question. The team then watched to see which patients survived their hospital stay and which did not. Out of the 162 people, 19 passed away, while the rest were discharged alive. This group of survivors and non-survivors provided the data needed to see if the blood scores told a different story than the injury scores.
The results painted a clear picture of who was most at risk. The patients who died had significantly more severe injuries and were in much worse physical condition when they arrived, with lower levels of consciousness and higher scores indicating greater physiological stress. When the researchers looked at the blood scores, a distinct pattern emerged for one of the three tools. The patients who died had significantly lower scores on the Prognostic Nutritional Index compared to those who survived. This index, which measures the body's protein reserves and immune cell count, remained a strong predictor of death even after the researchers adjusted for how severe the physical injuries were. In fact, for every small increase in this score, the odds of dying dropped by nearly 20 percent. This suggests that a patient's underlying nutritional and immune health carries its own weight in survival, separate from the physical damage they sustained.
In contrast, the other two scores did not hold up as independent predictors. While the patients who died did have lower scores on the CALLY index, this difference disappeared once the severity of the injuries was taken into account. The CALLY index, which measures inflammation alongside nutrition and immunity, did not provide any extra information that the standard injury scores did not already offer. The HALP score, which includes red blood cells and platelets, showed no significant difference between those who lived and those who died. In statistical tests designed to see which tool was best at separating survivors from non-survivors, the Prognostic Nutritional Index performed the best, while the HALP score performed no better than a random guess.
The researchers concluded that among the three tools they tested, the Prognostic Nutritional Index is the most reliable indicator for predicting death in these critically injured patients. It appears that the body's ability to maintain its protein levels and immune function is a crucial factor in surviving the aftermath of severe trauma. While the CALLY and HALP scores are interesting measures of the body's state, they did not prove to be useful on their own for making these life-or-death predictions in this specific group of patients. The study highlights that looking at a patient's nutritional and immune baseline, alongside their physical injuries, offers a clearer window into their chances of survival. However, the authors noted that their findings come from a single hospital and a relatively small number of patients, meaning these results need to be confirmed in larger groups before they become a standard part of trauma care.
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