Güzide TOMAS, Mustafa DÜGER, Mustafa OĞUZ
Journal of Medicine and Palliative Care - 2026;7(4):756-763
Aims: Pulmonary embolism (PE) remains a major cause of morbidity and mortality, and early identification of high-risk patients is essential for guiding clinical management. Nutritional and inflammatory biomarkers such as serum LA index (lymphocyte countxserum albumin level), and composite indices including the HALP (hemoglobinxalbuminxlymphocyte/platelet) score have recently gained attention for their prognostic value in acute cardiovascular and thromboembolic conditions. However, their clinical utility in predicting acute and late mortality in PE has not been fully clarified. Methods: This retrospective study included 693 adult patients diagnosed with acute PE by computed tomography pulmonary angiography between 2016 and 2024. Demographic, clinical, laboratory, and echocardiographic parameters were collected. The prognostic performances of LA index, HALP score, and NLR were evaluated for predicting in-hospital and five year all-cause mortality using ROC analysis. Logistic regression was performed to identify independent predictors of mortality. Results: Of the 693 patients, 40 died during the index hospitalization and 653 were discharged alive. Among the discharged patients, 282 died during the 5-year follow-up period, while 371 remained alive at 5 years. Non-survivors were older and had significantly higher rates of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, arrhythmia, and malignancy (all p<0.05). Laboratory characteristics associated with mortality included lower hemoglobin, lymphocyte count, albumin, and calcium levels, and higher neutrophil count, troponin, C-reactive protein, NT-proBNP , RDW , and neutrophil-to-lymphocyte ratio (NLR) (all p<0.05). ROC analysis showed that the LA index had the highest discriminative ability for predicting in-hospital mortality (AUC=0.677), followed by the NLR (AUC=0.655) and the HALP score (AUC=0.652). For predicting 5-year mortality among discharged patients, the LA index also demonstrated the highest discriminative performance (AUC=0.663), followed by the NLR (AUC=0.637) and the HALP score (AUC=0.632). In multivariable analysis, increasing age (OR=1.08, p<0.001), malignancy (OR=9.34, p<0.001), chest pain (OR=0.57, p=0.010), and heart rate (OR=1.02, p<0.001) remained independent predictors of in-hospital mortality. For 5-year mortality, increasing age (OR=1.06, p<0.001), malignancy (OR=7.04, p<0.001), lower serum albumin levels (OR=0.94, p=0.001), and higher RDW values (OR=1.13, p=0.007) were independent predictors. Conclusion: Serum LA index and the HALP score provide meaningful prognostic information in patients with acute PE. Among the evaluated biomarkers, the LA index demonstrated the highest discriminative performance for predicting both in-hospital and 5-year mortality, whereas the HALP score showed acceptable discriminatory ability but did not remain an independent predictor after multivariable adjustment. These findings suggest that simple and inexpensive nutritional-inflammatory biomarkers may serve as complementary tools for risk stratification in patients with acute PE.
