Hemoglobin-Albumin-Lymphocyte-Platelet Score as a Predictor of Clinical Severity in Acute Bronchiolitis

Abstract

Background: Acute bronchiolitis (AB) is one of the most common lower respiratory tract infections in infants and young children and is a major contributor to hospital admissions in early childhood. It imposes a substantial burden on healthcare systems worldwide, particularly among children younger than 2 years. The clinical course ranges from a self-limited illness to severe respiratory failure requiring intensive care. However, reliable laboratory-based biomarkers to support the early identification of severe disease remain limited. Objectives: This study aimed to evaluate the prognostic utility of the hemoglobin-albumin-lymphocyte-platelet (HALP) score in assessing disease severity and clinical outcomes in children with AB admitted to the pediatric intensive care unit (PICU). Methods: In this retrospective cohort study, 100 children aged 1 to 24 months with AB were compared with 104 age-matched healthy controls to evaluate clinical and laboratory characteristics. Hematological and biochemical parameters, including hemoglobin level, lymphocyte count, platelet count, albumin level, and the calculated HALP score, were analyzed. The associations between the HALP score, clinical severity, and intensive care outcomes were assessed. Results: Patients with AB had significantly lower lymphocyte counts, albumin concentrations, and HALP scores than healthy controls (P < 0.05). Among PICU patients, children with severe bronchiolitis had markedly lower HALP scores than those with moderate disease. Receiver operating characteristic (ROC) analysis showed that the HALP score effectively distinguished both the presence of AB and disease severity. The HALP score demonstrated good discriminative ability for AB (area under the curve [AUC], 0.88; 95% CI, 0.82 - 0.93; cut-off, 80.91; sensitivity, 85%; specificity, 88.5%) and moderate performance in predicting severity (AUC, 0.67; 95% CI, 0.56 - 0.78; cut-off, 42.65; sensitivity, 57.1%; specificity, 75%). Conclusions: The HALP score appears to be a simple, inexpensive, and readily accessible biomarker that may facilitate early risk stratification and inform clinical decision-making in children with AB.