Can HALP (Hemoglobin, albumin, lymphocyte, and platelet) score distinguish malignant and benign causes of extrahepatic cholestasis in patients with extrahepatic bile duct obstruction?

Objective: Cholestatic diseases are common and classified as benign or malignant based on their etiology. HALP is a unique nutritional immune marker that combines indicators of nutritional status, including hemoglobin and albumin, with immune function markers like lymphocyte and platelet counts. We investigated the HALP score's ability to differentiate between benign and malignant causes in extrahepatic cholestasis patients.

Methods: This research was designed as cross-sectional and retrospective. Between 1 January 2020-1 January 2022, patients diagnosed with extrahepatic cholestasis were included. The diagnoses were confirmed using non-invasive imaging methods, ERCP (endoscopic retrograde cholangiopancreatography), and tissue biopsy results. Based on the type of extrahepatic biliary obstruction, either benign or malignant, the patients were divided into two groups. The HALP score was calculated by multiplying the patient's albumin (g/L), hemoglobin (g/L), and lymphocyte count (/L) and dividing by the platelet count (/L).

Results: In 121 of 216 patients, extrahepatic cholestasis was caused by benign factors, mostly choledocholithiasis, while malignant causes, predominantly pancreatic head cancer, were responsible for extrahepatic cholestasis in 95 patients. The malignant cholestasis group had significantly higher bilirubin levels (p<0.001), lower hemoglobin levels (p=0.005), lower albumin levels (p<0.001), higher lymphocyte counts (p<0.001), and higher platelet levels (p=0.001) compared to the benign cholestasis group. There was no considerable difference in the HALP score between the two groups, as indicated by a p-value of 0.741.

Conclusion: The HALP score could not distinguish between benign and malignant causes of extrahepatic cholestasis.