The Relationship between Frailty, Hemoglobin-Albumin-lymphocyte-Platelet (HALP) Score, and Systemic Inflammatory Index (SII) in Elderly Type 2 Diabetic Patients

Abstract

Aim: Frailty, a clinical syndrome of reduced physiological reserves and increased vulnerability, is a key concern in managing type 2 diabetes mellitus (T2DM). Biomarkers like the systemic inflammatory index (SII) and the hemoglobin-albumin-lymphocyte-platelet (HALP) score have shown promise in understanding the inflammatory and nutritional factors underlying frailty. Present study explored the relationship between frailty, HALP, and SII in elderly diabetic patients.

Method: We included diabetic patients aged 65 years and older who visited the institutional outpatient clinics. Participants were classified as frail or non-frail using the Edmonton Frail Scale. The SII and HALP score of the frail and non-frail diabetic subjects were compared.

Results: There were 112 and 189 subjects in frail and non-frail groups, respectively. Mean SII level of the frail patients was significantly higher than that of the non-frail diabetic subjects (911 ± 322 vs 568 ± 286), (p<0.001). Median HALP score of the frail group (35 [7-142]) was significantly lower than the HALP score of the non-frail group (54 [6-143]), (p<0.001). According to the ROC analyses, the sensitivity and specificity of HALP score (when lower than 38.7) in detecting frailty in diabetic patients were 76% and 59%, respectively. The sensitivity and specificity of SII (when higher than 652) in detecting frailty were 60% and 73%, respectively. Multivariate analyses revealed that both SII and HALP score were independent risk factors for frailty.

Conclusion: HALP and SII may serve as potential screening markers and warrant validation in larger longitudinal studies. We suggest that elevated SII and decreased HALP score in patients with T2DM should alert physicians for possible frailty.