Evaluation of the Hemoglobin, Albumin, Lymphocyte, and Platelet Score and Inflammatory Markers in Preterm Premature Rupture of Membranes

Why clinicians should know about it

• Picked for Embryology (paper of the day, 26 July 2026).

Abstract

PROBLEM: To evaluate the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and its relationship with inflammatory markers in patients with preterm premature rupture of membranes (PPROM), and to assess their association with gestational age and neonatal outcomes. METHOD OF STUDY: This retrospective study included 226 pregnant women diagnosed with PPROM between 24 and 34 weeks of gestation between 2023 and 2026. Patients were categorized according to gestational age at diagnosis as early PPROM (24 + 0 to < 32 + 0 weeks) and late PPROM (32 + 0 to 34 + 0 weeks). Demographic, clinical, and laboratory data were collected, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The HALP score was calculated using routine laboratory parameters. Receiver operating characteristic (ROC) analysis was performed to evaluate the ability of the HALP score and inflammatory markers to identify early PPROM. Multivariate logistic regression analysis was used to identify independent predictors of adverse neonatal outcomes. RESULTS: Patients in the early PPROM group delivered at significantly earlier gestational ages, had lower birth weights, and had longer latency periods than those in the late PPROM group (all p < 0.001). Inflammatory markers, including CRP, NLR, PLR, and SII, were higher in the early PPROM group, whereas hemoglobin, lymphocyte levels, and HALP scores were lower (all p < 0.05). Adverse neonatal outcomes were more frequent in the early PPROM group than in the late PPROM group (53.5% vs. 20.6%, p < 0.001). ROC analysis demonstrated that CRP had the highest diagnostic performance (AUC: 0.663), followed by SII and NLR, whereas HALP showed modest discriminative ability (AUC: 0.632). In multivariate analysis, only gestational age at diagnosis was identified as an independent predictor of adverse neonatal outcome. CONCLUSION: The HALP score and inflammatory markers were associated with earlier gestational age at PPROM diagnosis, suggesting a relationship with inflammatory and immunonutritional status. However, their ability to predict adverse neonatal outcomes was limited, and gestational age remained the primary determinant of neonatal prognosis. Therefore, HALP may be considered a complementary biomarker rather than a standalone prognostic tool.

Abstract as published, via PubMed.