Objective　To evaluate the association between the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and the prognosis of patients with myocardial infarction (MI).

Methods　Using data from the National Health and Nutrition Examination Survey of the United States from 1999 to 2018, patients with MI were identified and divided into four groups (Q1 to Q4) based on the quartiles of their HALP scores. The Schoenfeld residual method was used to test proportional hazards assumption. Three-tiered weighted Cox proportional hazards models were constructed: unadjusted, adjusted for demographic variables, and adjusted for all covariates. These models analyzed the association between HALP scores and all-cause mortality, with subgroup analyses performed. Restricted cubic spline regression was employed to validate potential nonlinear relationships. When significant nonlinearity was detected, two-stage linear regression based on threshold analysis was applied. Kaplan-Meier (K-M) curves were used to compare survival differences across HALP score groups.

Results　A total of 2,131 patients were enrolled with a median follow-up of 80 months. Significant differences were observed among the four groups in terms of age, sex, race, marital status, and other variables (P < 0.05). The K-M curve showed that survival rates in all scoring groups declined as the follow-up period increased; overall, the Q1 group had the lowest survival rate, the Q3 group had a relatively higher rate, and the long-term survival rate in the Q4 group was slightly lower than that in the Q3 group. HALP scores exhibited a J-shaped nonlinear association with all-cause mortality, with a turning point at 78.53. Cox regression analysis revealed that, after adjusting for covariates, HALP scores were negatively associated with mortality risk below the turning point, with each 1-unit increase corresponding to a 0.8% reduction in mortality risk. Beyond the turning point, the association between HALP score and mortality risk tended to plateaued, and the protective effect did not further increase. Subgroup analysis revealed an in-teraction between HALP score and race, with stronger protective effect observed in the other race group.

Conclusion　This study confirms a J-shaped nonlinear association between HALP score and all-cause mortality in MI patients, where higher scores associated with lower mortality risk below the threshold.

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