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Prognostic value of PIV and HALP scores in acute coronary syndrome

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Created On: 07/05/2026

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Key take away

Higher PIV and lower HALP scores independently predict mortality in acute coronary syndrome, with HALP showing superior prognostic accuracy.

Background

Acute coronary syndrome (ACS)—including unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI)—remains a prominent cause of global morbidity and mortality. Emerging inflammatory biomarkers and nutritional markers are gaining attention for improving risk stratification in ACS beyond traditional predictors. This study determined the prognostic utility of the pan-immune-inflammatory value (PIV) and the hemoglobin-albumin-lymphocyte-platelet (HALP) scores as independent determinants of outcomes in ACS.

Method

In this multicenter retrospective study, patients hospitalized with ACS were analyzed. Key clinical data, demographics, and laboratory parameters were collected. The PIV score was calculated as neutrophils × platelets × monocytes / lymphocytes, while the HALP score was derived via hemoglobin × albumin × lymphocytes / platelets. Associations with clinical variables and mortality prediction in ACS patients were assessed.

Result

Overall, 1,134 ACS patients (mean age: 62 ± 12 years) were incorporated. Higher PIV values exhibited significant positive correlations with white blood cell count (Rho = 0.574), troponin levels (Rho = 0.381), and C-reactive protein (CRP; Rho = 0.295), while illustrating negative correlations with high-density lipoprotein cholesterol (Rho = –0.101) and left ventricular ejection fraction (Rho = –0.316).

PIV independently predicted mortality at a cut-off value of ≥1074.2 (area under the curve [AUC] = 0.619; sensitivity 45%; specificity 79.9%). In contrast, the HALP score showed inverse relationships with age, troponin, CRP, and intensive care unit stay duration, and predicted mortality at a cut-off of ≤3.58 (AUC = 0.722; sensitivity 53.8%; specificity 82%). As per the comparative receiver operating characteristic curve analysis, the HALP score outperformed PIV in predicting mortality among ACS patients.

Conclusion

Both PIV and HALP scores are reliable, independent prognostic biomarkers in ACS, reflecting systemic inflammation and nutritional status. Incorporating these cost-effective, easily accessible biomarkers into routine clinical practice may improve early risk assessment, enhance mortality prediction, and support personalized treatment strategies for cardiovascular care.