Prognostic Implications of the Hemoglobin-Albumin-Lymphocyte-Platelet Index in Patients with Pemphigus

INTRODUCTION: Pemphigus is a chronic autoimmune blistering disease with substantial morbidity and mortality. Although the hemoglobin-albumin-lymphocyte-platelet (HALP) index, a composite marker reflecting inflammatory and nutritional status, exhibits prognostic value in various immune-related diseases, its potential in pemphigus remains elusive. In this study, we investigated prognostic significance of the HALP index in 69 patients with pemphigus diagnosed between 2001 and 2024. METHODS: We calculated the HALP index at diagnosis and stratified using maximally selected rank statistics, identifying a cutoff value of 45.9. Using Cox proportional hazards models, patients with low HALP index (≤45.9) had significantly poorer overall survival (OS) and lower remission rates than those with higher HALP. RESULTS: Our multivariate analysis independently associated immunosuppressant use with improved OS (HR = 0.32; 95% CI: 0.13-0.79; p = 0.013), while a low HALP index was an independent predictor of mortality (HR = 2.84; 95% CI: 1.06-7.60; p = 0.038). Additionally, low HALP index was also independently associated with a longer time to remission (HR = 0.55; 95% CI: 0.31-0.97; p = 0.039). CONCLUSION: The HALP index represents a simple and readily available biomarker that independently predicts survival and remission outcomes in patients with pemphigus, potentially helping risk stratification and personalized management in clinical practice.