Evaluation of systemic inflammation- and nutrition-based indices in the prediction of HPV persistence
Persistent high-risk human papillomavirus (HPV) infection is the primary etiological factor in cervical cancer, with HPV16 and HPV18 posing the greatest oncogenic risk. Although systemic inflammation and nutritional indices such as the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and Prognostic Nutritional Index (PNI) have prognostic value in various malignancies, their role in predicting HPV persistence remains unclear. This study aimed to evaluate the predictive value of HALP and PNI scores for one-year HPV persistence and additionally assessed other inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). This retrospective study included 470 HPV-positive women aged 31-67 years who were followed for at least one year between January 2021 and March 2025. Participants were categorized into Group N (HPV clearance, n = 271) and Group P (HPV persistence, n = 199) according to one-year HPV results. Baseline demographic, clinical, histopathological, and laboratory data were collected. HALP and PNI scores were calculated from hemoglobin, albumin, lymphocyte, and platelet counts, and inflammatory markers including NLR, PLR, and CRP were evaluated. Group comparisons were performed using appropriate statistical tests, and predictive performance was assessed using receiver operating characteristic (ROC) analysis. Continuous variables were standardized using Z-score transformation before multivariate logistic regression to minimize scale differences among predictors. Within a year, 271 (57.7%) of the 470 women achieved viral clearance, whereas 199 (42.3%) had persistent infection. No substantial differences were observed in demographic or histological parameters. Vaccination after diagnosis did not affect clearance rates. The median HALP and PNI scores were similar between groups and provided no discriminatory ability [HALP AUC = 0.475 (95% CI: 0.422-0.528); PNI AUC = 0.487 (95% CI: 0.434-0.540)], as did PLR [AUC = 0.513 (95% CI: 0.460-0.566)] and CRP [AUC = 0.462 (95% CI: 0.409-0.515)]. In contrast, NLR was significantly higher in the persistence group (p < 0.001) and demonstrated modest discriminatory ability [AUC = 0.623 (95% CI: 0.573-0.673)]. HPV16 and HPV18 positivity was strongly associated with persistence. When the researchers evaluated the subjects' systemic inflammatory and nutritional status, they found that HALP, PNI, PLR, and CRP did not provide effective predictive value for one-year HPV persistence. Conversely, NLR exhibited a promising capacity to function as a straightforward systemic inflammatory marker. The presence of HPV16 and HPV18 was found to be significantly associated with the persistence of the infection, thereby corroborating the established immune evasion mechanisms associated with these types. These findings underscore the necessity for prognostic markers that integrate both local mucosal immune responses and systemic inflammatory pathways to enhance risk stratification and management of HPV-related disease.
