The Association Between the HALP Score and Disease Severity in Patients with Diabetic Foot Disease Presenting to the Emergency Department: A Prospective Observational Study

Objective: Rapid assessment of disease severity in diabetic foot disease is essential in the emergency department. While the Wagner classification reflects local wound severity, the HALP score reflects systemic inflammatory and nutritional status. This study evaluated the association between the HALP score and Wagner stage and assessed its ability to identify advanced disease.
Material and Methods: This prospective, single-center observational study included 130 patients with diabetic foot disease. The primary outcome was the association between the HALP score and Wagner stage. Secondary outcomes included amputation, in-hospital mortality, and 28-day mortality. Group comparisons, ROC analysis, DeLong's test, and multivariable logistic regression were performed.
Results: The median age was 66 years, and 65.4% of the patients were male. Amputation was performed in 48.5% of patients, and the median Wagner stage was 4 (3–5). HALP scores did not differ according to amputation status (p=0.212) but were significantly lower in Wagner grade 5 than in grades 1–2, 3, and 4 (all adjusted p≤0.026). HALP demonstrated good discrimination for Wagner grade 5 disease (AUC=0.790, 95% CI, 0.712–0.868), outperforming hemoglobin, lymphocyte count, and platelet count while performing similarly to albumin. Lower HALP scores remained independently associated with Wagner grade 5 disease (adjusted OR=0.857, 95% CI, 0.794–0.925; p<0.001).
Conclusion: Lower HALP scores were independently associated with advanced diabetic foot disease. Rather than replacing the Wagner classification, the HALP score may serve as a complementary biomarker during the initial emergency department assessment.