Abstract / Summary
Abstract Background The prognostic role of immunological and nutritional scores in trauma patients, as in various other diseases, has been increasingly investigated. In this study, we evaluated the associations of the hemoglobin–albumin–lymphocyte–platelet (HALP) score, C-reactive protein–albumin–lymphocyte (CALLY) index, and Prognostic Nutritional Index (PNI) with in-hospital mortality and compared their prognostic performance in patients with polytrauma admitted to the intensive care unit (ICU). Methods This retrospective cohort study included 162 adult patients who were admitted to the ICU between June 2021 and June 2023 and diagnosed with polytrauma according to the Berlin criteria. The HALP score, CALLY index, and PNI were calculated using laboratory parameters obtained at admission. The primary outcome was in-hospital mortality. The independent prognostic value of the indices was assessed using logistic regression models, while their discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results In-hospital mortality occurred in 19 patients (11.7%). Non-survivors had lower Glasgow Coma Scale (GCS) scores [3 (3–5) vs. 10 (7–13); p < 0.001] and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) [25 (22–30) vs. 14 (9–19); p < 0.001] and Injury Severity Score (ISS) scores [41 (25–41) vs. 20 (18–27); p < 0.001]. Patients who died had lower CALLY [1.1 (0.3–4.9) vs. 3.4 (0.9–11.8); p = 0.036] and PNI [31.0 (21.0–37.0) vs. 38.0 (33.0–42.0); p = 0.001] values, whereas no significant difference was observed in HALP scores [1.9 (1.3–3.2) vs. 2.3 (1.6–3.5); p = 0.605]. In multivariable analysis, PNI was the only index independently associated with mortality after adjustment for ISS and GCS (OR = 0.803; 95% CI: 0.704–0.916; p = 0.001). Neither HALP (OR = 0.959; p = 0.611) nor CALLY (OR = 0.966; p = 0.194) demonstrated independent prognostic value. In standalone ROC analysis, PNI showed the numerically highest discriminative performance (AUC = 0.740; 95% CI: 0.607–0.873), whereas the AUC values for CALLY and HALP were 0.648 and 0.537, respectively. Conclusions PNI was independently associated with in-hospital mortality in ICU patients with polytrauma and demonstrated the numerically highest discriminative performance among the indices evaluated.