Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepatectomy for hepatocellular carcinoma

The association between C-reactive protein-albumin-lymphocyte index and depression in adults with type 2 diabetes mellitus: A cross-sectional study from NHANES

OBJECTIVE

Inflammation and nutrition are interrelated, and both are related to depression. This study explored the association between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a novel immunonutrition scoring system, and depression in patients with type 2 diabetes mellitus (T2DM).

METHODS

We included 3517 patients with T2DM from the National Health and Nutrition Examination Survey 2005-2010 and 2015-2018. The Patient Health Questionnaire-9 was used to evaluate depression. The CALLY index was based on a comprehensive assessment of serum CRP, serum albumin, and the lymphocyte counts from whole blood. Weighted multivariate logistic regression models were used to examine the relationship between the CALLY index and depression. The restricted cubic spline was applied to explore the nonlinear relationship.

RESULTS

Compared with the non-depressed group, CALLY index and albumin in the depressed group were significantly reduced, while CRP and lymphocytes were significantly increased (P < 0.05). After adjusting for covariates, only the CALLY index significantly decreased (the highest quartile vs the lowest quartile, odds ratio = 0.58, 95 % confidence interval: 0.38-0.89, P = 0.014). The non-linear association between the CALLY index and depression was not significant (P for nonlinear=0.69). The results of subgroup analysis were basically consistent (P for interaction > 0.05).

CONCLUSION

The CALLY index was significantly negatively correlated with depression in American patients with diabetes and served as a potential marker for early identification.

Association Between the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index and Length of Hospital Stay in Patients With Heart Failure

Prolonged hospital stays for patients with heart failure (HF) are associated with increased morbidity and mortality. In this study, we investigated the relationship between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a new marker in patients with decompensated HF, and the length of hospital stay. Consecutive patients (n = 4745) who were hospitalized with decompensated HF between January 2016 and January 2024 (COVID-19 period was excluded) were included in the study. The CALLY index ([albumin × lymphocyte]/[CRP × 104]) was calculated. A relationship was found between the CALLY index and the length of hospital stay in the patients with HF in linear regression analysis. Also, the CALLY index was an independent predictive variable of the length of hospital stay (odds ratio: 0.327; 95% CI: 0.278-0.385; P < .001). CALLY index value of 0.258 can predict long-term hospitalization with 69.2% sensitivity and 70.1% specificity (area under the curve [AUC]: 0.729, 95% CI = 0.714-0.743, P < .001). In addition, the CALLY index was negatively correlated with the length of hospital stay (r = -.47, P < .001). In conclusion, the CALLY index, an inexpensive and easily measured laboratory variable, may be a valuable for estimating the length of hospital stay in decompensated HF.

The Impact of Nutritional Support on Outcomes of Lung Cancer Surgery-Narrative Review

Background: Malnutrition is a prevalent yet often overlooked issue in lung cancer patients, significantly affecting surgical outcomes. This review examines the impact of nutritional status on lung cancer surgery and explores the role of nutritional assessment and intervention strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Key studies on nutritional status assessment, preoperative nutritional support, and their impact on surgical outcomes were analyzed. Results: Malnutrition in lung cancer patients is associated with increased postoperative complications, prolonged hospital stays, and reduced survival rates. Various assessment tools, including dietary interviews, physical examinations, laboratory tests, and body composition analyses, can help identify malnourished patients. Nutritional support strategies such as high-protein diets, oral supplements, enteral and parenteral nutrition, and perioperative immunomodulation improve clinical outcomes. Conclusions: Implementing standardized nutritional assessment and support protocols is crucial for optimizing surgical outcomes in lung cancer patients. Integrating these strategies into the Enhanced Recovery After Surgery (ERAS) protocol may further enhance recovery and long-term prognosis.

The Potential of the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index as a Prognostic Biomarker in Colorectal Cancer

Background/Aim

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is an innovative immunonutritional biomarker calculated from CRP, serum albumin, and lymphocyte count levels. This study aimed to determine the significance of the preoperative CALLY index as a prognostic biomarker in patients with stage II-III colorectal cancer who underwent colorectal surgery.

Patients and Methods

This retrospective study included 223 patients who underwent colorectal surgery for stage II-III colorectal cancer. The CALLY index was calculated as follows: (albumin × lymphocyte)/(CRP × 104). The patients were divided into CALLY-high group (n=112) and CALLY-low group (n=111) according to the preoperative CALLY index. The associations between the preoperative CALLY index and recurrence-free survival (RFS) and overall survival (OS) were evaluated.

Results

The cutoff value of the CALLY index was 3.41. The Kaplan-Meier survival curves for both RFS and OS in patients with stage II-III colorectal cancer demonstrated worse outcomes in the CALLY-low group than in the CALLY-high group (p=0.062 and p=0.008, respectively). A subgroup analysis of both stage II and stage III showed that patients in the CALLY-low group who did not receive postoperative adjuvant chemotherapy had the worst RFS and OS.

Conclusion

The preoperative CALLY index may serve as a prognostic biomarker in patients with colorectal cancer. Additionally, a low CALLY index may indicate a poorer prognosis, particularly in patients who did not receive postoperative adjuvant chemotherapy.

C-reactive Protein-albumin-lymphocyte Index Is a Useful Indicator for Recurrence and Survival Following Curative Resection of Stage I-III Colorectal Cancer

Objectives

Recently, several simple inflammation-based prognostic scores that can be calculated easily from serum parameters, have been reported to be related to colorectal cancer prognosis. This study aimed to investigate factors influencing the prognosis of patients, including inflammation-based prognostic scores, with stage I-III colorectal cancer following curative resection.

Methods

This single-center study included 608 patients with stage I-III colorectal cancer who underwent curative resection between April 2010 and December 2018. A retrospective analysis was performed to identify the prognosis-associated variables in these patients. As a multi-center study, the Hiroshima Surgical study Group of Clinical Oncology database was used to analyze 1659 patients with stage I-III colorectal cancer who underwent curative resection to confirm the results of our single-center study.

Results

Of the inflammation-based prognostic scores, only preoperative C-reactive protein-albumin-lymphocyte index was revealed to predict a poor prognosis in patients with stage I-III colorectal cancer following curative resection. The low C-reactive protein-albumin-lymphocyte index was associated with poor overall survival and recurrence-free survival, which was similar in patients from multi-center database. The C-reactive protein-albumin-lymphocyte index was found to be associated with patient age, systemic condition, comorbidities, and tumor factors. The time-dependent area under the curve for the postoperative proghosis of the C-reactive protein-albumin-lymphocyte index was superior to those of other inflammation-based prognostic scores in most postoperative observation periods.

Conclusions

The preoperative C-reactive protein-albumin-lymphocyte index was independently associated with long-term prognosis in patients with stage I-III colorectal cancer following curative resection.

Lower CALLY index levels indicate higher poor functional outcome risk in acute ischemic stroke patients treated with endovascular thrombectomy

Background

The imbalance in the nutrition-immunity-inflammation status is linked to the prognosis of various diseases. This study sought to evaluate the correlation between the C-reactive protein-albumin-lymphocyte (CALLY) index and the outcomes of acute ischemic stroke (AIS) managed with endovascular thrombectomy (EVT).

Methods

This study retrospectively enrolled 473 AIS patients who underwent EVT from a multicenter investigation. Poor functional outcome was defined as a modified Rankin scale score exceeding 2 points at 90 days after EVT. The cutoff value for the CALLY index was determined using the receiver operating characteristic curve. Multivariable logistic regression models were utilized to explore the association between the CALLY index and poor functional outcome and restricted cubic splines was used to illustrate the relationship between the CALLY index and the risk of poor functional outcome after EVT.

Results

Poor functional outcomes occurred in 214 (45.2%) patients at 90 days after EVT. The cutoff for the CALLY index was 10^ (-0.635). Multivariate logistic regression revealed that the CALLY index was significantly associated with poor functional outcome (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.70-0.91, p < 0.001; high versus low OR: 0.64, 95% CI: 0.41-1.00, p = 0.048). The restricted cubic spline analysis indicated an inverse association between the CALLY index and the risk of poor functional outcome (P for nonlinearity = 0.373).

Conclusion

Our study identified that a lower CALLY index is an independent predictor of poor functional outcome after EVT. The CALLY index could emerge as a practical, cost-effective, and promising predictive biomarker for adverse outcomes in AIS patients undergoing EVT treatment.

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index exhibits an L-shaped association with all-cause mortality in rheumatoid arthritis patients: a retrospective cohort study

BACKGROUND

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a novel biomarker reflecting inflammation, nutrition, and immune status, and its potential clinical significance and prognostic role in patients with rheumatoid arthritis (RA) has not been reported.

AIM

The objective of this study was to investigate whether CALLY is associated with all-cause mortality in RA patients.

METHODS

The characteristics of 1101 RA patients and 18,047 non-RA individuals were collected from the National Health and Nutrition Examination Survey (NHANES) database between 1999 and 2010. The CALLY index is calculated as albumin × lymphocyte count / (CRP × 10). Multivariable Cox regression models were used to assess the association between the CALLY index and all-cause mortality in RA patients. Restricted cubic spline (RCS) analysis was applied to evaluate potential linear or nonlinear relationships between the CALLY index and mortality. Kaplan-Meier survival curves were used to assess survival probabilities across different CALLY levels in RA patients.The final analysis was conducted on July 10, 2024.

RESULTS

Multivariable logistic regression analysis indicated that a low CALLY index was significantly associated with RA patients when compared to non-RA individuals, with an odds ratio (OR) of 0.74 (95% CI: 0.65-0.83). Cox regression models revealed that RA patients with a higher CALLY index showed a decreased risk of all-cause mortality, with a hazard ratio (HR) of 0.62 (95% CI: 0.51-0.77). RCS analysis demonstrated a L-shaped relationship between the CALLY index and survival outcomes of RA patients. Segmented regression identified an optimal cutoff value for the CALLY index at 12.79, where values below this threshold were inversely correlated with all-cause mortality risk. Subgroup analysis suggested a synergistic interaction between a high Log-CALLY index, male, and age below 60 years. Kaplan-Meier survival curve analysis showed significantly higher survival rates in the high CALLY group compared to the low CALLY group (P = 0.0012).

CONCLUSIONS

The CALLY index is a valuable biomarker for evaluating the prognosis of patients with RA, and a lower CALLY index indicates an increased long-term mortality risk in RA patients, which suggests the importance of comprehensive assessment for inflammatory status and immune function.

CLINICAL TRIAL NUMBER

Not applicable.

The value of the CRP-albumin-lymphocyte index (CALLY index) as a prognostic biomarker in acute ischemic stroke

This study aims to evaluate the predictive capability of CRP-albumin-lymphocyte (CALLY) index in relation to hemorrhagic transformation (HT) and functional outcome in acute ischemic stroke (AIS). A total of 439 AIS patients were included in this analysis. Multivariate logistic regression was conducted to examine the relationship between the CALLY index, HT, and functional outcomes. To address its non-linear association, a restricted cubic spline (RCS) model identified an optimal threshold for the CALLY index. Subgroup analyses further explored the association between the CALLY index and HT. The receiver operating characteristic (ROC) curve, the net reclassification index (NRI), and the integrated discrimination index (IDI) were used to assess and compare the predictive performance of the CALLY index with established models for HT. Furthermore, mediation analysis was performed to elucidate the causal pathways linking the CALLY index, HT, and functional outcomes. Among the participants, 9.79% (43/439) experienced HT, and 49.32% (182/369) encountered adverse outcomes. A higher CALLY index was associated with a lower risk of developing HT (OR 0.449, 95% CI 0.283-0.713) and poor outcome (OR 0.691, 95% CI 0.558-0.855). RCS curves demonstrated an increased risk of HT when the CALLY index fell below 1.188. Compared to existing HT prediction models, the CALLY index demonstrates superior predictive performance, with an AUC of 0.746. Furthermore, the CALLY index exhibits improved reclassification ability, as indicated by enhanced NRI and IDI values. The CALLY index independently predicts HT and adverse outcomes in AIS, demonstrating superior accuracy to existing risk scores and offering a practical biomarker for clinical prognosis.

Association of CALLY index and CLR with COPD risk in middle-aged and older Americans: evidence from NHANES 2017-2020

Background

Chronic obstructive pulmonary disease (COPD) is marked by restrictions on airflow, leading to a gradual and irreversible reduction in lung function. This study assessed the predictive value of hematological inflammatory biomarkers, specifically the C-reactive protein-albumin-lymphocyte (CALLY) index and the C-reactive protein to lymphocyte ratio (CLR), for determining COPD risk in United States adults aged 40 and above.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) covering the period from 2017 to March 2020. The relationship between inflammatory markers, including the CALLY index, CLR, and their components, and COPD was assessed using multivariate logistic regression. Subgroup analyses explored the relationship between the CALLY index, CLR, and COPD, while restricted cubic spline (RCS) analyses evaluated potential non-linearity. The predictive performance of these biomarkers for COPD risk was assessed using receiver operating characteristic (ROC) curve analysis.

Results

After controlling for confounders, for every one-unit increase in the CALLY index (converted to natural logarithm), the prevalence of COPD decreased by 19% (OR = 0.81, 95% CI: 0.71-0.92, P = 0.001). Conversely, for every one-unit increase in the CLR (converted to natural logarithm), the prevalence of COPD increased by 23% (OR = 1.23, 95% CI: 1.08-1.40, P < 0.001). The linear negative correlation between the CALLY index and COPD was demonstrated by using RCS curves, while the CLR exhibited a positive association. After being fully adjusted, both the CALLY index and the CLR yielded an adjusted area under the curve (AUC) of 0.831 for predicting the risk of COPD, demonstrating excellent predictive capability.

Conclusion

The study identifies a linear negative relationship between the CALLY index and COPD, unaffected by potential confounders. A higher CLR is linked to an elevated risk of COPD development. Both the CALLY index and CLR were superior in predicting the risk of developing COPD. Our findings emphasize that the CALLY index and CLR may be a new inflammatory early warning biomarker for COPD.

Integrating inflammation, nutrition, and immunity: the CALLY index as a prognostic tool in digestive system cancers - a systematic review and meta-analysis

BACKGROUND

Digestive system cancers remain a leading cause of cancer-related mortality globally, underscoring the need for reliable prognostic tools. The C-reactive protein-Albumin-Lymphocyte (CALLY) index, which reflects inflammation, nutrition, and immunity, has shown potential in predicting survival. However, comprehensive evaluations of its role in digestive system cancers are still limited.

METHODS

A meta-analysis of English-language studies from online databases was performed to assess the prognostic value of the CALLY index. Pooled hazard ratios (HRs) were calculated for overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and cancer-specific survival (CSS).

RESULTS

A total of eighteen articles (19 studies, encompassing 7,951 patients) were included. A lower CALLY index was significantly associated with poorer outcomes across all survival endpoints. The pooled HR for OS was 1.973 (95% CI: 1.734-2.244), with HRs for DFS, RFS, and CSS being 2.093 (95% CI: 1.682-2.604), 1.462 (95% CI: 1.292-1.654), and 2.456 (95% CI: 1.887-3.221), respectively (all P < 0.001). Subgroup analyses for OS demonstrated consistent prognostic significance across various treatment strategies, cancer types, cutoff values, sample sizes, and regions. Notably, the CALLY index was a strong predictor of OS in surgical patients (HR = 2.014, 95% CI: 1.794-2.260, P < 0.001). Sensitivity analyses validated the robustness of these findings, with minimal publication bias (Egger's test P = 0.053).

CONCLUSIONS

The CALLY index serves as a cost-effective and reliable biomarker for predicting prognosis in digestive system cancers. Its utility as a pre-treatment risk stratification tool, which integrates key factors of inflammation, nutrition, and immunity, renders it valuable for guiding clinical decision-making.

Prognostic and clinicopathological significance of C-reactive protein-albumin-lymphocyte(CALLY) in patients with digestive system neoplasms: a systematic review and meta-analysis

OBJECTIVE

The prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in digestive system neoplasms (DSNs) has been investigated in several studies, but inconsistencies remain between the results of different studies. Therefore, the aim of this study was to confirm the prognostic significance of CALLY in patients with DSNs and its association with clinicopathological characteristics (CPCs).

METHODS

The databases PubMed, Cochrane Library, Web of Science, Research Square and Embase were systematically searched for clinical trials with databases up to 1 November 2024. The value of CALLY in predicting overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS) versus cancer-specific survival (CSS) in patients with DSNs was confirmed by calculating the combined hazard ratio (HR) and 95% CI. The combined OR and 95% CI were calculated to assess the association between CALLY and CPCs in patients with DSNs.

RESULTS

A total of 18 studies with 7916 patients with DSNs were included in this study. Pooled analysis showed that lower CALLY was associated with poor OS, DFS, RFS and CSS were significantly associated. In addition, low CALLY index was associated with male gender, T3-T4, lymph node metastasis, lymph vessel invasion, complications, stage III-IV and surgical approach were significantly associated. However, there was no association between low CALLY index and histological type, adjuvant chemotherapy, and neoadjuvant chemotherapy.

CONCLUSIONS

In this meta-analysis, a low CALLY index was significantly associated with poor OS, DFS, RFS and CSS in patients with DSNs and with several CPCs in patients with DSNs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024622973.

Association between C-reactive protein-albumin-lymphocyte index and stroke: an NHANES analysis (1999-2010)

Objective

This cross-sectional study is based on the NHANES (1999-2010) database and aims to explore the potential relationship between the CALLY index and stroke in the U.S. population.

Methods

This cross-sectional study utilized data from NHANES (1999-2010), including 17,511 American participants after data cleaning. Laboratory markers related to the CALLY index were obtained through standardized biological sample collection and analysis procedures performed by trained professionals. Stroke status was determined based on self-reported questionnaires. Various statistical methods were employed to examine the association between the CALLY index and stroke, as well as its predictive efficacy for stroke risk, including multivariable logistic regression, subgroup analysis, RCS analysis, and ROC analysis.

Results

Among the 17,511 participants analyzed, our findings revealed a nonlinear L-shaped negative association between the CALLY index and stroke risk. In Model 3, a higher CALLY index was significantly associated with a lower stroke risk (OR: 0.99, 95% CI: 0.98-0.99, p = 0.045). Additionally, participants in the highest quartile (Q4) of the CALLY index had a 25% lower likelihood of stroke compared to those in the lowest quartile (Q1) (OR: 0.75, 95% CI: 0.58-0.97, p = 0.030). Furthermore, ROC analysis demonstrated that the CALLY index had superior predictive performance for stroke risk compared to the SIRI and SII indices.

Conclusion

A reduced CALLY index may be linked to a higher risk of stroke. Furthermore, the CALLY index demonstrates superior predictive performance compared to the SIRI and SII indices. The association between the CALLY index and stroke risk provides valuable insights for future stroke prevention and management strategies.

Correlation between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index and the prognosis of gastric cancer patients after gastrectomy: a systematic review and meta-analysis

The C-Reactive Protein (CRP)-Albumin-Lymphocyte (CALLY) index is an established immuno-nutritional scoring system. We screened relevant literature from the major databases up until May, 2024, and extracted the data for analysis. A total of 2829 gastric cancer (GC) patients from six studies were included in this meta-analysis, the results of which revealed that the CALLY index was an independent prognostic factor for OS and RFS in both univariate analyses and multivariate analyses, and that a high CALLY index was a favorable prognostic factor. Moreover, GC patients in the high CALLY index group seemed to have better 5-year OS and 5-year RFS than those in the low CALLY index group. There was a higher proportion of patients with T1 status in the high CALLY index group than in the low CALLY index group. However, the opposite results were found in the analyses of lymph node metastasis positivity, lymph-vascular invasion positivity, postoperative complications, differentiated histological type, anastomotic leakage, and adjuvant chemotherapy. The present meta-analysis concluded that the CALLY index was a simple and useful independent prognostic biomarker for GC patients after gastrectomy.

A novel indicator of all-cause mortality in acute coronary syndrome: the CALLY index

AIMS

This study aimed to identify the prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index for predicting all-cause mortality in acute coronary syndrome (ACS) patients who have undergone primary percutaneous coronary intervention (pPCI) for revascularization.

MATERIALS AND METHODS

505 patients who presented with ACS and underwent pPCI were retrospectively included in this single center study. CALLY index and other five prognostic scores were calculated. The median follow-up was 40 months. All-cause mortality was defined as the primary endpoint.

RESULTS

The median age of the patients was 59 years, 23.4% were female. The CALLY index was categorized into low (<0.7) and high (≥0.7). Age (p = 0.038), concomitant atrial fibrillation (p = 0.023), previous CABG (p = 0.001), ACE-I/ARB/ARNI use (p = 0.015), diuretic use (p = 0.021), and a low-CALLY index (p < 0.001) were identified as independent predictors of all-cause mortality in multivariate cox regression analysis. When compared to other prognostic scores according to AUC in ROC analysis, the CALLY index demonstrated the best ability to predict all-cause mortality. Additionally, patients with a high-CALLY index exhibited significantly better survival outcomes compared to those with a low-CALLY index (log-rank:p < 0.001).

CONCLUSIONS

CALLY index can be utilized as a novel prognostic score for predicting all-cause mortality in ACS patients who have undergone pPCI.

CRP-Albumin-Lymphocyte index (CALLYI) as a risk-predicting biomarker in association with osteoarthritis

PURPOSE

As a novel biomarker, the C-reactive protein-Albumin-Lymphocyte Index (CALLYI) offers a comprehensive evaluation of the human body from three perspectives. However, the association between CALLYI and the incidence of osteoarthritis (OA) remains unclear. This cross-sectional study investigates the potential relationship between CALLYI and OA in US adults, develops a clinical prediction model, and validates its effectiveness.

METHOD

The study cohort consisted of 18,624 U.S. adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The CALLYI was calculated using the formula: albumin * lymphocytes / CRP * 10. Three weighted multiple regression models were constructed to investigate the correlation between CALLYI and OA. Restricted cubic splines (RCS) were employed to evaluate the nonlinear relationship between these two variables. Subgroup analyses were conducted to examine interactions. Univariate logistic regression, binary logistic regression, and least absolute shrinkage and selection operator (LASSO) were utilized for variable selection in the prediction model. Decision curve analysis (DCA) and receiver operating characteristic (ROC) curve analysis were applied to assess the predictive performance of the models.

RESULTS

The total sample size analyzed in this study was 18,624, of which 1,977 (10.62%) were diagnosed with OA. And the mean value of CALLYI was 5.13 (2.12,12.86). The multivariate logistic regression model revealed a negative correlation between elevated CALLYI and OA. The fully adjusted Model 3 demonstrated a significant 28% reduction in OA risk in the Q4 compared to the Q1 of CALLYI (OR = 0.72 95% CI: 0.59-0.88, p = 0.001). Subgroup analyses did not reveal any significant interactions (p > 0.05). Additionally, a significant non-linear relationship between CALLYI and OA using RCS (p < 0.0001). After variable screening, we constructed an OA prediction model incorporating CALLYI, and the results were visualized using a nomogram. The area under the curve (AUC) was 0.825 (95% CI: 0.817-0.834), and DCA indicated that the model holds clinical significance.

CONCLUSION

This study, utilizing NHANES statistics, is the first to establish a nonlinear negative relationship between CALLYI and OA, with no significant interaction observed in subgroup analyses. In the OA prediction model incorporating CALLYI, we validated the effectiveness and clinical utility of this model, providing evidence that CALLYI can serve as a biomarker for OA risk prediction. Nevertheless, larger multicenter prospective cohort studies are necessary to mitigate the limitations inherent in cross-sectional designs and self-reported OA diagnoses.

Prognostic utility of the CALLY index in metastatic melanoma: building a nomogram for Patients on Anti-PD-1 therapy

BACKGROUND

Despite the success of immune checkpoint inhibitors (ICIs) in metastatic melanoma, many patients fail to derive meaningful benefit, underscoring the urgent need for accessible prognostic biomarkers. The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, an immunonutritional index, has shown prognostic value in various cancers. Previous studies indicate that systemic inflammation and nutritional status influence ICI efficacy, suggesting the potential relevance of the CALLY index in metastatic melanoma. This study evaluates the CALLY index's role in metastatic melanoma patients treated with anti-PD-1 therapy.

METHODS

This retrospective study analysed 92 patients with metastatic melanoma who were treated with anti-PD-1 monotherapy at Ege University's Faculty of Medicine between 2015 and 2023. The CALLY index was calculated using the pre-treatment CRP, albumin and lymphocyte levels. Kaplan-Meier analysis was used to estimate survival outcomes, and univariate and multivariate Cox regression models were employed to identify independent prognostic factors. A predictive nomogram incorporating the CALLY index and other significant variables was then developed.

RESULTS

The optimal CALLY index cutoff was determined to be 2. Patients with a low CALLY index (≤ 2) had worse median overall survival (OS) and progression-free survival (PFS) when compared with those who had a high CALLY index (> 2) (median OS: 9.6 vs 31.3 months, p < 0.001; median PFS: 3.8 vs 10.6 months, p = 0.001). Multivariate analysis identified the CALLY index, lactate dehydrogenase above the upper limit of normal, Eastern Cooperative Oncology Group score ≥ 2, M1c/M1d staging and acral/mucosal melanoma subtypes to be independent predictors of OS. A nomogram was then constructed based on these factors, yielding a concordance index of 0.705 (95% confidence interval: 0.634-0.776). This model stratified patients into low-, intermediate- and high-risk groups, with the high-risk group showing significantly worse OS than the intermediate- and the low-risk groups (p < 0.001).

CONCLUSION

The CALLY index is a cost-effective and independent prognostic biomarker that can aid in risk stratification and guide treatment decisions in patients with metastatic melanoma receiving anti-PD-1 therapy.

The association between the C-reactive protein-to-albumin-to-lymphocyte index and retinopathy: insights from a population-based study

Introduction

Retinopathy is a multifactorial disease influenced by metabolism, immunity, inflammation, and other factors. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immunonutritional score that has shown promise in various health contexts. This study aims to investigate the association between the CALLY index and retinopathy risk, and to compare its predictive performance with other established inflammatory markers.

Methods

Data from 5,439 participants in the 2005-2008 National Health and Nutrition Examination Survey (NHANES) were utilized. Multivariable-weighted logistic regression was employed to assess the association between the CALLY index and retinopathy risk. Additionally, the predictive performance of the CALLY index was compared with other inflammatory markers. Mediation analysis was conducted to explore potential mediating factors in the association between the CALLY index and retinopathy.

Results

Multivariable-weighted logistic regression revealed a significant inverse association between the CALLY index and retinopathy risk (OR = 0.96, 95% CI = 0.94-0.98, P = 0.002). Participants in the highest CALLY index quartile exhibited a markedly lower risk of retinopathy (P < 0.001). The CALLY index demonstrated superior predictive performance compared to other inflammatory markers, with an area under the curve (AUC) of 0.672 (95% CI = 0.643-0.701). Mediation analysis indicated that high-density lipoprotein (HDL) levels partially mediated the association between the CALLY index and retinopathy.

Discussion

These findings highlight the CALLY index as a reliable, independent biomarker for retinopathy risk assessment, outperforming traditional inflammatory markers and oering potential clinical value for early identification of retinopathy in individuals with chronic diseases.

Impact of C-reactive protein-albumin-lymphocyte index as a prognostic marker for the patients with undergoing gastric cancer surgery

Introduction

The significance of the C-reactive protein-albumin-lymphocyte index [CALLY index (CI)] as a prognostic factor in gastric cancer remains unexplored. Therefore, this study assessed the utility of the CI as a predictor of short-term postoperative outcomes and long-term prognosis after gastric cancer surgery.

Methods

This study consisted of two cohorts. Cohort 1 included 120 patients who underwent distal gastrectomy for clinical stages I-III primary gastric cancer between November 2022 and March 2024. Patients were categorized into high- and low-CI groups, and complications were classified accordingly. Propensity score matching was performed based on clinical stage, surgical approach, and lymph node dissection extent, yielding 40 matched cases. The relationship between preoperative CI and short-term postoperative outcomes was analyzed. Cohort 2 included 358 patients with pathological stages I-III gastric cancer who underwent distal gastrectomy between January 2014 and December 2017. Preoperative CI was assessed, and its association with long-term outcomes was evaluated. Prognostic factors were also analyzed.

Results

In Cohort 1, the preoperative CI was associated with short-term postoperative outcomes. Compared with the high-CI group, the low-CI group developed significantly more complications, including postoperative pneumonia. In Cohort 2, the 5-year overall survival (OS) and recurrence-free survival (RFS) differed significantly between the high and low CI groups. CI was an independent prognostic factor for OS and RFS.

Conclusion

The CI reflects patients' overall systemic conditions and may be a valuable predictor of short-term outcomes and long-term prognosis following gastric cancer surgery.

Prognostic value of CRP-albumin-lymphocyte index in patients with intrahepatic cholangiocarcinoma after radical resection

Purpose

The aim of this study is to explore the prognostic value of CRP-Albumin-Lymphocyte (CALLY) index in patients undergoing radical resection of intrahepatic cholangiocarcinoma (ICC).

Patients and methods

Retrospectively collected clinical data of 286 patients with ICC who underwent radical surgery at Shandong Provincial Hospital from July 2010 to July 2021. Univariate and multivariate analyses were used to evaluate the correlation between the CALLY index and overall survival (OS) and recurrence-free survival (RFS), and a nomogram prediction model was established based on the results. The accuracy of the model was evaluated using concordance index (C-index), calibration curves, decision curve analysis (DCA), and the receiver operating characteristic (ROC) curve was used to compare the prognostic value of the nomogram model with the TNM staging system.

Results

The optimal cut-off value of CALLY index was 1.81. In the training set, multifactorial Cox regression analysis showed that CALLY index <1.81 was an independent risk factor for OS and RFS (p < 0.05). Compared to neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and modified Glasgow prognostic score (mGPS), CALLY index had a higher area under the curve (AUC). The nomogram established based on the results of multifactorial analysis demonstrated strong efficacy in survival prediction, and the ROC curve showed that the nomogram had a higher prognostic value than TNM staging.

Conclusion

The CALLY index is independently associated with OS and RFS in patients after radical resection of ICC, and the nomogram model based on it shows significantly higher efficacy in predicting the long-term prognosis of patients after radical resection of ICC, and is more accurate than TNM staging.

Novel indicator for erectile dysfunction: the CALLY index, evidence from data of NHANES 2001-2004

Purpose

This study explored the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and erectile dysfunction (ED).

Patients and methods

Data from 2,128 participants in the 2001-2004 National Health and Nutrition Examination Survey (NHANES) were analyzed and classified into ED and non-ED groups.Additionally, a separate analysis of complete erectile dysfunction was conducted.A weighted multiple logistic regression model was used to assess the association between CALLY and ED, while smooth curve fitting was applied to explore their linear relationship.ROC analysis was conducted to compare the predictive accuracy (AUC) of CALLY, Systemic Inflammation Response Index (SIRI), Systemic Immune-Inflammation Index (SII), Aggregate Index of Systemic Inflammation (AISI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and the product of platelet count and neutrophil count (PPN) for ED.

Results

After adjustment, Ln-CALLY was negatively associated with ED (OR = 0.77, 95% CI: 0.69-0.85, p < 0.0001) and complete ED (OR = 0.88, 95% CI: 0.78-1.00, p = 0.0450).The highest Ln-CALLY tertile (Q3) was associated with a significantly lower risk of ED compared to Q1 (OR = 0.40, 95% CI: 0.30-0.55, p < 0.0001).A similar trend was observed for complete ED (OR = 0.57, 95% CI: 0.38-0.85, p = 0.006).Curve fitting revealed a negative correlation between CALLY and both types of ED.Subgroup analysis confirmed the consistent and independent association.CALLY exhibited superior predictive performance for ED (AUC = 0.6512) and complete ED (AUC = 0.6237) compared to other markers.

Conclusion

Higher CALLY levels were linked to a reduced ED risk and proved a superior predictor compared to other inflammatory markers.

Associations of the C-reactive protein-albumin-lymphocyte index with all-cause and cardiovascular mortality among individuals with cardiovascular disease: evidence from the NHANES 2001-2010

BACKGROUND

Evidence regarding the C-reactive protein‒albumin‒lymphocyte (CALLY) index and mortality risk in individuals with cardiovascular disease (CVD) is scarce. This study investigated the relationships of the CALLY index with all-cause and cardiovascular mortality risk in CVD patients among American adults.

METHODS

This study enrolled 2183 CVD individuals from five NHANES cycles (2001-2010), and mortality outcomes were determined by linking the data to National Death Index (NDI) records up to December 31, 2019. Weighted multivariate Cox regression models and subgroup analyses were performed to assess the associations of the CALLY index with all-cause and cardiovascular mortality. A restricted cubic spline (RCS) was used to visualize the association of the CALLY index with mortality risk.

RESULTS

During a median follow-up of 122 months (interquartile range, 71-157 months), 1208 (weighted percentage, 49.62%) of the 2183 CVD individuals died, including 398 (weighted percentage, 24.85%) with cardiovascular deaths and 810 (weighted percentage, 75.15%) with noncardiovascular deaths. Cox regression revealed an inverse correlation between the CALLY index and the risk of all-cause and cardiovascular mortality after adjusting for covariates. Compared with individuals with a lower CALLY index, those with a higher CALLY index had a significantly lower risk of both all-cause (HR 0.58, 95% CI: 0.48, 0.71, p < 0.001) and cardiovascular mortality (HR 0.54, 95% CI: 0.38, 0.76, p < 0.001). The RCS regression analysis revealed a nonlinear association between the CALLY index and all-cause and cardiovascular mortality (p < 0.05 for nonlinearity) in CVD patients. The associations were consistent in the subgroup analyses regardless of age, sex, income, education level, race, smoking status, diabetes, and hypertension (all p values for interactions > 0.05).

CONCLUSION

An increased CALLY index is independently associated with decreased all-cause and cardiovascular mortality in CVD patients.

Inverse association between CALLY index and angina pectoris in US adults: a population-based study

BACKGROUND

The C-reactive protein-albumin-lymphocyte (CALLY) index is a significant marker that reflects both inflammatory and nutritional states and has proven to be a valuable tool for assessing prognosis in various medical conditions. However, the connection between it and angina pectoris has not yet been fully examined. This research sought to thoroughly investigate the possible link between the CALLY index and angina pectoris.

METHODS

This research utilized a cross-sectional approach, drawing data from the 2003-2010 National Health and Nutrition Examination Survey (NHANES), which included 16,291 adults from the U.S. The CALLY index was calculated based on lymphocyte counts, serum albumin concentrations, and C-reactive protein (CRP) levels. The relationship between the CALLY index and angina pectoris was analyzed using multivariate logistic regression and restricted cubic spline (RCS) methods. Subgroup and interaction analyses were also performed.

RESULTS

Elevated ln CALLY was inversely correlated with the prevalence of angina (OR: 0.88, 95% CI: 0.82, 0.95). Those in the highest quartile of the ln CALLY (Q4) were 38% less likely to experience angina than those in the lowest quartile (Q1) (OR: 0.62, 95% CI: 0.46, 0.84). RCS analysis revealed an L-shaped curve linking the CALLY index to angina, with a cutoff at 14. The consistency of this relationship was substantiated through subgroup analyses across different population groups.

CONCLUSIONS

This research highlights a notable inverse relationship between the CALLY index and angina in U.S. adults, suggesting its potential as an innovative tool for evaluating angina.

Blood Cell Ratio Combinations for Diagnosing Periprosthetic Joint Infections: A Preliminary Study

Background

Periprosthetic joint infection (PJI) is a serious complication following total joint arthroplasty (TJA), which requires prompt and accurate diagnosis for effective management. Many biomarkers have been used for PJI diagnosis; however, the identification of the most effective inflammatory biomarker combination for optimal diagnostic accuracy may be poorly reported.

Methods

In this prospective, multi-center study, a total of 269 individuals undergoing knee or hip revision arthroplasty were recruited and subsequently categorized based on 2018 ICM PJI criteria into two groups: 93 with periprosthetic joint infection (PJI) and 176 with aseptic failure (AF). Various preoperative biomarkers were analyzed and compared, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), CRP-to-albumin ratio (CAR), CRP-Albumin-lymphocyte ratio (CALLR), platelet-to-lymphocyte ratio (PLR), platelet-to-albumin ratio (PAR), and neutrophil-to-albumin ratio (NAR). The diagnostic performance of these biomarkers was evaluated using ROC curve analysis and the area under the curve (AUC). Additionally, the Youden index was used to determine optimal threshold values, and positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate diagnostic precision.

Results

In the PJI group, levels of PAR, CAR, and CALLY were notably higher compared to the AF group, reaching statistical significance (P < 0.05). PAR and CAR were confirmed to have high diagnostic values, with AUC values of 0.779 and 0.718, respectively. CALLY exhibited moderate diagnostic effectiveness, with an AUC of 0.647. When PAR was combined with CRP and ESR, sensitivity and specificity notably improved to 93.8% and 92.5%, respectively. However, subgroup analysis revealed no significant differences in combined inflammatory biomarker levels between the two groups.

Conclusion

PAR and CAR prove to be effective combined inflammatory biomarkers for PJI diagnosis, whereas other markers exhibited limited diagnostic utility for PJI.

Association between the C-reactive protein-albumin-lymphocyte index and metabolic syndrome: evidence from the 2003-2010 national health and nutrition examination survey

BACKGROUND

Metabolic syndrome (MetS) is a global public health problem that significantly impacts human health and quality of life. The relationship between MetS and the C-reactive protein-albumin-lymphocyte (CALLY) index is uncertain.

METHODS

This study analyzed the data of 7,534 individuals from the National Health and Nutrition Examination Survey cycles (2003-2010 cycles). Weighted logistic regression and weighted restricted cubic spline (RCS) curve analyses were used to identify the relationships between the CALLY index and MetS, as well as its components.

RESULTS

Of the 7,534 participants, 2,086 were diagnosed with MetS. The estimated prevalence of MetS decreased with an increase in the CALLY index (P < 0.001). Multivariable logistic regression analysis showed that the odds ratio of MetS was 0.25 (95% confidence interval 0.20-0.32, P < 0.001) in the highest CALLY index quartile compared with the lowest quartile after adjusting for confounding variables. The RCS curve analysis revealed non-linear relationships between the CALLY index and MetS or its components.

CONCLUSIONS

This study revealed an inverse relationship between the CALLY index and MetS risk. The CALLY index might be valuable for identifying individuals who are at a high risk of MetS.

CLINICAL TRIAL NUMBER

Not applicable.

The Association Between the CALLY Index and All-Cause Mortality in Patients with COPD: Results from the Cohort Study of NHANES 2007-2010

Purpose

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a newly developed biomarker that combines measurements of CRP, serum albumin, and lymphocyte count. This index provides a thorough assessment of a patient's inflammation level, nutritional condition, and immunological function. The objective of this study is to examine the correlation between the CALLY index and all-cause mortality in COPD patients.

Methods

We calculated the CALLY index using data from the National Health and Nutrition Examination Survey (NHANES) for the 2007-2008 and 2009-2010 cycles, extracted from the participants' peripheral blood samples. The study utilized Kaplan-Meier curves, restricted cubic spline (RCS) curves, and Cox regression analysis to evaluate the relationship between the CALLY index and the risk of all-cause mortality in COPD patients. To assess the predictive accuracy of the CALLY index, we calculated the area under the receiver operating characteristic (ROC) curve (AUC).

Results

The study included 1,048 participants and found a significant negative correlation between the CALLY index and all-cause mortality in patients with COPD. The CALLY index was a major predictor of survival in COPD patients [fully adjusted model: in the 3rd quartile, HR = 1.61, 95% CI: 1.02-2.52, p = 0.039; in the 2nd quartile, HR = 2.11, 95% CI: 1.22-3.65, p = 0.008; in the 1st quartile, HR = 3.12, 95% CI: 2.00-4.85, p < 0.001]. The RCS curves demonstrated a non-linear association between the CALLY index and all-cause mortality in COPD patients. The areas under the curve (AUC) in predicting 5- and 10-year all-cause mortality were 0.693 and 0.656.

Conclusion

The CALLY index has a strong relationship with all-cause mortality in patients with COPD in the US and could serve as a prognostic biomarker for these patients.

The Prognostic Significance of the CALLY Index in Ampullary Carcinoma: An Inflammation-Nutrition Retrospective Analysis

Background

As a novel inflammatory-nutritional biomarker, the C-reactive protein-albumin-lymphocyte (CALLY) index has demonstrated significant prognostic value in various malignancies. However, research on its association with the prognosis of ampullary carcinoma (AC) is rare. This study aims to investigate the relationship between the CALLY index and the prognosis of patients with AC.

Methods

We retrospectively analyzed data from 201 patients with AC at Sun Yat-sen University Cancer Center. Several clinicopathological factors and biomarkers were included in the study. Univariate and multivariate Cox regression analyses, along with competing risk analysis, were performed to identify prognostic factors for AC after pancreaticoduodenectomy (PD). Only factors with significant results in univariate analysis were included in multivariate analysis. To ensure the robustness of our findings, propensity score matching (PSM) analyses were conducted to assess survival differences according to the CALLY index.

Results

The univariate and multivariate Cox regression analyses revealed that pathological type, N stage, T stage, postoperative chemotherapy regimen, and the CALLY index were all statistically significant prognostic factors for patients with AC after PD (all P values < 0.05). Taking into account non-cancer-related mortality as competing hazards, these factors remained significant predictors (all P values < 0.05). After PSM, the survival advantage observed between the low and high CALLY groups remained discernible and consistent.

Conclusion

This study indicated that a reduced CALLY index correlates with a poorer cancer-specific survival in AC patients after PD, highlighting its utility as a prognostic marker for this condition.

Predictive Value of Albumin to Fibrinogen Ratio and CALLY Index for Diagnosis of Ulcerative Colitis and Mucosal Healing After Vedolizumab Treatment

Purpose

The albumin to fibrinogen ratio (AFR), a biomarker associated with inflammatory, nutritional, and coagulation status, and the CALLY index, a biomarker combining C-reactive protein, albumin, and lymphocyte count, have been suggested to correlate with prognosis in a variety of diseases in previous studies; however, studies of these two markers in ulcerative colitis (UC) are lacking. The aim of this study was to evaluate the clinical significance of AFR and CALLY index in UC.

Methods

The study included 109 UC patients and 126 healthy controls. For UC patients treated with Vedolizumab (50 patients), they were categorized into mucosal healing group (MH group) and non- mucosal healing group (non-MH group) based on Mayo endoscopic score (MES) after 14 weeks of treatment. The differences in AFR and CALLY index were compared between the UC group and the healthy control group, and between the MH group and the non-MH group. Then, the correlation of the AFR and CALLY index with UC activity was assessed, and the predictive value of the AFR and CALLY index was evaluated using the receiver operating characteristic (ROC) curve.

Results

The results showed that both AFR and CALLY index were significantly decreased in the UC group compared with the healthy control group (both p<0.001); the area under the curve (AUC) of the AFR and CALLY index differentiating between the healthy control group and the UC group were 0.782 and 0.773, respectively. For Vedolizumab treatment, the non-MH group had significantly lower baseline AFR and CALLY index compared to the MH group; the AUC for baseline AFR and CALLY index discriminating the MH group from the non-MH group were 0.665 and 0.721, respectively. In addition, AFR and CALLY index were negatively correlated with the MES and inflammatory load of UC. The results of multivariate logistic regression analysis showed that the CALLY index was an independent predictor of UC diagnosis and mucosal healing after 14 weeks of Vedolizumab treatment.

Conclusion

AFR and CALLY index can be used as novel serologic markers for diagnosing UC and predicting the efficacy of Vedolizumab treatment.

IINS Vs CALLY Index: A Battle of Prognostic Value in NSCLC Patients Following Surgery

Objective

This research sought to assess the predictive potential of the inflammation-immunity-nutrition score (IINS) and the high-sensitivity C-reactive protein-albumin-lymphocyte (CALLY) index in individuals with NSCLC post-surgery.

Methods

The study enrolled 506 patients with NSCLC undergoing R0 resection at the First Affiliated Hospital of Xi'an Jiaotong University. The training cohort was analyzed utilizing X-tile software to identify the ideal threshold values for categorizing high-sensitivity C-reactive protein, albumin, lymphocyte count, and the CALLY index. The predictive significance of the IINS and CALLY index was evaluated through Kaplan-Meier survival curves and univariate and multivariate Cox regression analyses. Predictive capabilities of the IINS and CALLY index were compared utilizing receiver operating characteristic (ROC) curve analysis, time-dependent ROC curve analysis, and decision curve analysis (DCA). Internal validation was performed in the validation cohort and all data from both the training and validation cohorts using Kaplan-Meier curves and DCA.

Results

Patients with lower IINS exhibited prolonged overall survival (OS), whereas those with lower CALLY had shorter OS. Multivariate analysis identified N stage, NSE, and IINS as independent prognostic factors for individuals with NSCLC. ROC analysis revealed that IINS provided superior prognostic performance to CALLY and other traditional indicators (CAR, PLR, and NLR). Time-dependent ROC analyses and DCA further confirmed the superior prognostic value of IINS over the CALLY index at 1, 2, and 3 years.

Conclusion

This study reveals that both the IINS and CALLY index are effective in forecasting the prognosis of individuals with NSCLC following surgery, with the IINS demonstrating superior prognostic efficacy to the CALLY index.

Association between NAFLD and liver fibrosis with nutritional risk index based on the NHANES 2017-2018

BACKGROUND

Nutrition and its associated inflammation have been acknowledged as vital factors in the etiopathogenesis of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis. The nutritional risk index (NRI) has been widely recognized as a valid indicator of nutritional status in several diseases, including osteoporosis and cardiovascular disease. However, the role of NRI in NAFLD and liver fibrosis remains unclear.

METHODS

Participants were selected from the National Health and Nutrition Examination Survey data for the 2017-2018 cycle. Association between NRI and both NAFLD and liver fibrosis was evaluated using multiple logistic regression and restricted cubic spline (RCS) analysis. Mediation analysis was employed to assess the influence of inflammation on the association between NRI and both NAFLD and liver fibrosis.

RESULTS

Compared to their respective control groups, individuals with NAFLD and liver fibrosis exhibited higher NRI levels. Multiple logistic regression analyses indicated that NRI was positively associated with the odds of NAFLD and liver fibrosis across both continuous scales and quantile groups, with adjustments for relevant covariables. The RCS model demonstrated a dose-response effect between NRI and the odds of NAFLD, but not with liver fibrosis. Receiver operating characteristic (ROC) analysis revealed the area under the ROC curves of 0.798 and 0.775 for NAFLD and liver fibrosis, respectively. Mediation analysis showed that inflammation accounted for 3.139% of the effect of NRI on the odds of NAFLD, suggesting inflammation might partially mediate the impact of NRI on NAFLD.

CONCLUSIONS

Our findings indicate that NRI may serve as a potential associated marker for these liver diseases, underscoring the importance of nutritional status in their etiopathogenesis.

Changes in Skeletal Muscle Volume During Preoperative Chemotherapy Affect the Outcome of Pancreatic Cancer

BACKGROUND

This study aimed to investigate the effects of changes in clinicopathological factors during preoperative chemotherapy for pancreatic cancer, including skeletal muscle volume, on recurrence and prognosis after pancreatectomy.

METHODS

Data from 41 patients who underwent resection for pancreatic cancer after preoperative chemotherapy from 2012 to 2021 were retrospectively reviewed. Skeletal muscle volume was substituted for the psoas muscle area (PMA) at the level of the third lumbar vertebra. We investigated the relationship of clinicopathological factors during preoperative chemotherapy with disease-free survival (DFS) and overall survival (OS). The association between clinicopathological factors and a decrease in PMA was investigated.

RESULTS

In the multivariate analyses for DFS and OS, the factors associated with recurrence were as follows: decrease in PMA (P = 0.003) and the absence of adjuvant therapy (P = 0.03), and the factors associated with poor prognosis were as follows: decrease in PMA (P = 0.04) and the absence of adjuvant therapy (P = 0.008), and the resectability of borderline resectable and unresectable-locally advanced tumors (P = 0.033). All patients with partial response according to the Response Evaluation Criteria in Solid Tumors (version 1.1) had no decrease in PMA (P = 0.01). The proportion of patients with Evans classification ≥ II was significantly higher in the group without a decrease in PMA (P = 0.02). The proportion of patients with an average relative dose intensity of adjuvant therapy ≥0.6 was significantly higher in the group without a decrease in PMA (P = 0.02).

CONCLUSION

Changes in preoperative skeletal muscle volume during preoperative chemotherapy for pancreatic cancer is a potential predictor of recurrence and prognosis after pancreatectomy.

A Machine Learning Model for the Prediction of No-Reflow Phenomenon in Acute Myocardial Infarction Using the CALLY Index

BACKGROUND

Acute myocardial infarction (AMI) constitutes a major health problem with high mortality rates worldwide. In patients with ST-segment elevation myocardial infarction (STEMI), no-reflow phenomenon is a condition that adversely affects response to therapy. Previous studies have demonstrated that the CALLY index, calculated using C-reactive protein (CRP), albumin, and lymphocytes, is a reliable indicator of mortality in patients with non-cardiac diseases. The objective of this study is to investigate the potential utility of the CALLY index in detecting no-reflow patients and to determine the predictability of this phenomenon using machine learning (ML) methods.

METHODS

This study included 1785 STEMI patients admitted to the clinic between January 2020 and June 2024 who underwent percutaneous coronary intervention (PCI). Patients were in no-reflow status, and other clinical data were analyzed. The CALLY index was calculated using data on patients' inflammatory status. The Extreme Gradient Boosting (XGBoost) ML algorithm was used for no-reflow prediction.

RESULTS

No-reflow was detected in a proportion of patients participating in this study. The model obtained with the XGBoost algorithm showed high accuracy rates in predicting no-reflow status. The role of the CALLY index in predicting no-reflow status was clearly demonstrated.

CONCLUSIONS

The CALLY index has emerged as a valuable tool for predicting no-reflow status in STEMI patients. This study demonstrates how machine learning methods can be effective in clinical applications and paves the way for innovative approaches for the management of no-reflow phenomenon. Future research needs to confirm and extend these findings with larger sample sizes.

Negative association of C-reactive protein-albumin-lymphocyte index (CALLY index) with all-cause and cause-specific mortality in patients with cancer: results from NHANES 1999-2018

BACKGROUND

The CALLY index, which is derived from C-reactive protein (CRP) content, serum albumin level, and total lymphocyte count, reflects the immune, nutritional, and inflammatory status of the body. Lack of sufficient evidence on the correlation between the CALLY index and the prognosis of cancer patients with various cancer forms. This study seeks to elucidate the association between the CALLY index and mortality from all causes as well as specific causes in cancer patients within a U.S.

POPULATION

METHODS

This investigation encompassed 3511 cancer-afflicted adults from the National Health and Nutritional Examination Surveys (NHANES) spanning 1999 to 2018. The CALLY index was measured at baseline only. The relationship between the CALLY index and mortality from both all causes and cancer specifically was examined using Cox proportional hazards models. Additionally, restricted cubic spline, piecewise linear regression, and various subgroup and sensitivity analyses were employed.

RESULTS

Over a median follow-up of 103 months, 1,355 deaths occurred, and the incidence of all-cause mortality for these participants was 38.34%. Our findings indicate that an elevated CALLY index correlates with a diminished risk of all-cause mortality. Upon applying a natural logarithmic transformation to the CALLY index, the comprehensively adjusted model revealed that each one-unit increment in ln CALLY corresponded to a 18% decrease in all-cause mortality risk among cancer patients (HR = 0.82, 95% CI:0.79-0.86). Analyses of mortality due to cardiac and cancer-related causes yielded consistent results, which were robust across various subgroup and sensitivity analyses.

CONCLUSION

The CALLY index demonstrated a linear and negative association with all-cause mortality, as well as mortality caused by cancer and cardiac conditions, highlighting its significant prognostic value in patients with oncological conditions.

Clinical significance of the CALLY index in patients with gastric cancer undergoing gastrectomy

BACKGROUND

The aim of this study was to elucidate the clinical impact of the CALLY index in patients with gastric cancer (GC) undergoing gastrectomy.

METHODS

Between January 2014 and December 2020, 617 patients who underwent gastrectomy for GC at the Osaka City General Hospital were enrolled in this study. The CALLY index was calculated using the following formula: [albumin (g/dL) × lymphocytes (/μl)]/[CRP (mg/dL) × 104]. We compared the predictive value of four biomarkers [CALLY index, modified Glasgow prognostic score (mGPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR)] for short- and long-term outcomes and focused on the CALLY index to elucidate its clinical value.

RESULTS

Receiver operating characteristic analysis showed that the area under the curve for the CALLY index was the highest among the four biomarkers. The 5-year overall survival (OS) and cancer-specific survival (CSS) rates in the low and the high CALLY groups were statistically significant. Multivariate analysis identified the CALLY index as an independent factor for OS and CSS but not NLR or PLR. The mGPS was an independent factor for OS but not for CSS in multivariate analysis. Regarding complications, only the CALLY index was an independent predictor of major complications (≧ Clavien-Dindo grade 3) in multivariate analysis but not others.

CONCLUSIONS

The CALLY index may have a clinical value in predicting OS, CSS, and major complications in GC patients undergoing gastrectomy.

C-reactive Protein-albumin-lymphocyte Index as a Novel Biomarker for Progression in Patients Undergoing Surgery for Renal Cancer

Background/Aim

Some patients with renal cell carcinoma (RCC) develop early or late recurrence after surgery. However, there is no clear consensus on which patients with postoperative RCC should be treated. This study aimed to establish a biomarker for selecting patients who are at a higher risk of relapse following renal cancer surgery.

Patients and Methods

A total of 378 patients who underwent nephrectomy or partial nephrectomy for a diagnosis of RCC at our hospital were included, with a focus on pT3 cases at high risk of recurrence. Factors associated with postoperative progression, including pathological and hematological parameters, were examined.

Results

Sarcomatoid features, Fuhrman grade 4, and C-reactive protein-albumin-lymphocyte (CALLY) index were statistically significant predictive factors for progression-free survival after surgery (p<0.0011, p=0.0047, and p<0.0001, respectively). In the multivariate Cox proportional regression analysis, the CALLY index was the most statistically significant predictor of the risk of postoperative recurrence (p=0.0002).

Conclusion

In addition to the existing risk factors for RCC recurrence, such as sarcomatoid features and Fuhrman grade, we propose that the CALLY index is a predictor of postoperative recurrence and that patients with a low CALLY index are good candidates for postoperative treatment. Our study may help select patients with pT3 disease with a high risk of recurrence who require postoperative treatment.

Usefulness of the C-Reactive Protein (CRP)-Albumin-Lymphocyte (CALLY) Index as a Prognostic Indicator for Patients With Gastric Cancer

BACKGROUND

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a novel immune nutrition scoring system associated with cancer prognosis. This study investigated the association between the CALLY index and the long-term outcomes of patients with gastric cancer.

METHODS

We included 175 patients with gastric cancer who underwent curative gastrectomies at the Department of Surgery, International University of Health and Welfare Hospital between January 2011 and October 2019. The CALLY index was calculated based on the levels of serum albumin, serum CRP, and peripheral lymphocyte count. Utilizing both univariate and multivariate analyses, the prognostic value of the CALLY index was investigated.

RESULTS

In the multivariate analyses, disease stage (hazard ratio [HR], 7.85; 95% confidence interval [CI], 3.31-18.6; P < .01), microvascular invasion (HR, 2.88; 95% CI, 1.30-6.36; P < .01), and low CALLY index (HR, 2.18; 95% CI, 1.00-4.76; P = .05) were independent and significant predictors of disease-free survival. Low body mass index (HR, 4.15; 95% CI, 1.63-10.6; P < .01), advanced disease stage (HR, 8.22; 95% CI, 3.47-19.5; P < .01), and low CALLY index (HR, 3.00; 95% CI, 1.3-6.93; P = .01) were independent and significant predictors of overall survival. The low CALLY index group had a lower body mass index (P < .01), advanced disease stage (P < .01), and a higher Glasgow prognostic score (P < .01).

CONCLUSIONS

The CALLY index may be associated with a poor prognosis for gastric cancer, highlighting the utility of a comprehensive assessment using inflammatory, nutritional, and immunological statuses.

Clinical usefulness of C-reactive protein-albumin-lymphocyte (CALLY) index as a prognostic biomarker in patients undergoing surgical resection of pancreatic cancer

PURPOSE

The C-reactive protein-albumin-lymphocyte (CALLY) index, which simultaneously evaluates the nutritional, immunological, and inflammatory statuses, is a new prognostic biomarker in patients with various cancers; however, no study has reported the clinical significance of the CALLY index in patients with pancreatic cancer. This study aimed to investigate whether the preoperative CALLY index is a prognostic biomarker in patients undergoing surgical resection of pancreatic cancer.

METHODS

We retrospectively enrolled 461 patients with pancreatic cancer who underwent surgical resection between January 2013 and December 2022. The overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional hazards regression models.

RESULTS

The optimal cut-off value for the preoperative CALLY index was 1.9. In the low CALLY group, patients were older (p = 0.012), more patients underwent pancreaticoduodenectomy (p = 0.002), the median tumor size was larger (p < 0.001), more patients had pathologically confirmed metastatic lymph nodes (p = 0.015) and worse pathological stage (p = 0.015), and fewer patients received adjuvant chemotherapy (p = 0.003). A low CALLY index was associated with decreased OS (22.1 vs. 37.9 months) and RFS (12.4 vs. 16.4 months). Univariate and multivariate analyses showed that the preoperative CALLY index was an independent prognostic factor for OS (p < 0.001) and RFS (p = 0.045).

CONCLUSION

The preoperative CALLY index is a prognostic biomarker for both OS and RFS in patients undergoing surgery for pancreatic cancer.

New Approaches Based on Inflammatory Indexes in the Evaluation of the Neoplastic Potential of Colon Polyps

Colorectal polyps, precursors to colorectal cancer (CRC), require precise identification for appropriate diagnosis and therapy. This study aims to investigate the differences in hematological and inflammatory markers, specifically the CALLY index, HALP score, and immuno-inflammatory indexes, between neoplastic and nonneoplastic polyps. A retrospective cross-sectional study was conducted on 758 patients aged 61.0 ± 11.8 who underwent polypectomy between June 2021 and May 2024. Patients with colorectal adenocarcinoma (n = 22) were excluded. The polyps were classified into neoplastic and nonneoplastic categories based on histopathological evaluation. The study compared the CALLY index, HALP score, and various inflammatory indexes between neoplastic and nonneoplastic polyps. Out of 758 polyps analyzed, 514 were neoplastic, and 244 were nonneoplastic. Neoplastic polyps exhibited significantly lower CALLY and HALP scores (p < 0.05) and higher immuno-inflammatory indexes (p < 0.05) compared to nonneoplastic polyps. Dysplasia status, polyp diameter, and sigmoid colon localization were significant factors in determining neoplastic growth potential. No significant differences were observed in polyp localization in the proximal and distal colon segments or in solitary versus multiple polyps. The CALLY and HALP scores and immuno-inflammatory indexes can serve as valuable markers for distinguishing neoplastic from nonneoplastic polyps. These indexes reflect underlying inflammatory and immune responses, highlighting their potential utility in the early detection and risk stratification of colorectal polyps. Integrating these markers into clinical practice may enhance diagnostic accuracy and improve patient management, leading to timely interventions and better outcomes for individuals at risk of CRC.

C-reactive protein-albumin-lymphocyte index as a feasible nutrition-immunity-inflammation marker of the outcome of all-cause and cardiovascular mortality in elderly

BACKGROUND & AIMS

The imbalance of nutrition-immunity-inflammation status might be associated with the mortality risk in the elderly. This study aimed to assess the relationship between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index and all-cause and cardiovascular disease (CVD) mortality in the elderly.

METHODS

The data from records of older adults (≥ 60 years) were derived from 1999 to 2010 and 2015-2018 National Health and Nutrition Examination Survey. Weighted Cox proportional hazard regression was used to analyze the relationship between CALLY and all-cause mortality and CVD mortality in three different models, and the linear trend was analyzed. A restricted cubic spline model was used to evaluate the nonlinear dose-response relationship and determine the critical threshold of CALLY to divide the population into two groups. Kaplan-Meier analysis and log-rank test were used to evaluate the cumulative survival rates of different groups. Subgroup analyses and sensitivity analyses were performed to ensure robustness.

RESULTS

Compared to the first quartile of natural log-transformation (ln) CALLY, the highest quartile of ln CALLY was negatively correlated with the risk of all-cause mortality (HR = 0.67, 95% CI: 0.56-0.79. P < 0.05) and CVD mortality (HR = 0.65, 95% CI: 0.47-0.89. P < 0.05) in model 3. Ln CALLY was linear dose-response correlated with mortality. We determined that the critical threshold for ln CALLY in elderly was 1.00. Elderly with higher ln CALLY (≥ 1.00) had significantly increased survival rates (P < 0.05).

CONCLUSION

CALLY showed a significant negative linear association with the risk of all-cause mortality and CVD mortality, and higher CALLY was beneficial to the survival outcomes of the elderly.

Preoperative predictors of very early recurrence in patients with hepatocellular carcinoma beyond the Milan criteria

PURPOSE

Hepatocellular carcinoma (HCC) patients beyond the Milan criteria (MC) who undergo liver resection have high recurrence rates and poor prognosis, and sometimes experience very early recurrence (VER) within six months after surgery. This study aimed to identify predictive factors, including the newly proposed C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, for VER after surgery for HCC beyond MC.

METHODS

We included patients who underwent initial liver resection for HCC beyond MC between 2000 and 2021. We defined VER as recurrence within six months after surgery and compared the clinicopathological factors and long-term prognosis between the VER and non-VER groups. Multivariate analysis identified risk factors for VER and evaluated the potential for prognostic stratification using these factors.

RESULTS

The overall survival (OS) and post-recurrence survival were significantly worse in the VER group compared to patients with recurrence in 7-12 months, over 12 months, and without recurrence (median survival time (MST) 1.16 vs. 5.14, 7.26, and undefined; and MST 0.81 vs. 4.34, and 5.48, respectively, P < 0.01). Alpha-fetoprotein (AFP) ≥ 200, non-simple nodule (SN) type on preoperative imaging, and CALLY index < 2.8 were independent prognostic factors (P < 0.01 for all). An increased risk factor count was correlated with poorer VER and OS rates, allowing for effective stratification.

CONCLUSION

VER after hepatic resection for HCC beyond MC was associated with a significantly poorer prognosis. AFP, non-SN type on imaging, and CALLY index are valuable preoperative indicators. Patients with multiple risk factors have a worse prognosis and may be candidates for multimodal treatment.

Associations of C-reactive protein-albumin-lymphocyte (CALLY) index with cardiorenal syndrome: Insights from a population-based study

Background

Cardiorenal syndrome (CRS) is a complex condition characterized by the interplay of immune imbalance and inflammation. The C-reactive protein-Albumin-lymphocyte (CALLY) CALLY index serves as a new immune-nutritional scoring system, but its predictive value for CRS remains to be established.

Methods

In this study, we analyzed data from 27,978 participants in National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The CALLY index was calculated as the ratio of albumin to lymphocyte, divided by C-reactive protein (CRP) multiplied by 104. CRS was defined by the coexistence of cardiovascular disease and chronic kidney disease (eGFR <60 mL/min/1.73 m2). Multivariate weighted logistic regression models were employed to determine the odds ratio and 95 % confidence interval for the association between the CALLY index and CRS. Receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) curves were used to assess the predictive efficacy and nonlinear relationship, respectively.

Results

The prevalence of CRS in the study population was 1.22 %. Our findings revealed a significant inverse relationship between the CALLY index and CRS risk, with lower CALLY index values being associated with a higher likelihood of CRS (OR = 0.95, 95 % CI = 0.94-0.96, P < 0.001). Participants in higher quartiles of the CALLY index showed a progressively reduced risk of CRS (P for trend <0.001). Moreover, the CALLY index demonstrated superior predictive performance compared to other inflammatory indicators, such as systemic immune-inflammation index (SII), neutrophil/high-density lipoprotein ratio (NHR), lymphocyte/high-density lipoprotein ratio (LHR), monocyte/high-density lipoprotein ratio (MHR), and platelet/high-density lipoprotein ratio (PHR) (AUC = 0.672, 95 % CI = 0.643-0.701).

Conclusions

This study underscores the significant negative correlation between the CALLY index and the risk of cardiorenal syndrome. The CALLY index emerges as a robust and independent predictor of CRS, outperforming traditional inflammatory markers. This finding highlights the potential utility of the CALLY index as a clinical tool for identifying individuals at risk for CRS.

Prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index on outcomes after gastrectomy for gastric cancer

PURPOSE

Systemic inflammatory response markers are reported to be prognostic for patients with cancer. The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index has been established as an immuno-nutritional scoring system. The aim of this study was to clarify the impact of the preoperative CALLY index on the outcome of patients undergoing gastrectomy for gastric cancer.

METHODS

We analyzed the data of 826 patients who underwent gastrectomy for stage I, II, or III gastric cancer between 2010 and 2017. The CALLY index was defined as (albumin × lymphocyte)/(CRP × 104).

RESULTS

The cut-off of the CALLY index was 2. The 147 patients with a preoperative CALLY index < 2 had significantly worse overall survival (OS) and relapse-free survival (RFS) than those with a CALLY index ≥ 2 (P < 0.01, P < 0.01, respectively). Multivariate analysis identified that a CALLY index < 2 (P = 0.02), intraoperative blood loss (P < 0.01), and stage II or III disease (P < 0.01) were independent and significant predictors of worse RFS. A CALLY index < 2 (P = 0.01), intraoperative blood loss (P < 0.01), postoperative complications (P = 0.02), and stage II or III disease (P < 0.01) were independent and significant predictors of worse OS.

CONCLUSION

The preoperative CALLY index was independently associated with a poor prognosis for patients after gastrectomy for gastric cancer.

The effect of indicators of CALLY index on survival in glioblastoma

INTRODUCTION

Glioblastoma is the most common primary brain tumor in adults. Recently, research has been published on the potential prognostic indicators associated with different types of cancer. Due to the limited availability of data investigating the relationship between the CALLY index and glioblastoma patients, we aimed to conduct this study.

MATERIALS AND METHODS

Between January 2017 and December 2023, we conducted a study on patients diagnosed with glioblastoma. We collected demographic data and routine laboratory tests at the time of admission. To calculate the CALLY index, we used the formula (albumin value × lymphocyte count) / CRP value × 104. Parameters were compared for in-hospital mortality across different groups.

RESULTS

The study analyzed 202 patients who met the inclusion criteria. Of these, 165 (81.7%) were classified as "survivors" and 37 (18.3%) as "deceased." A comparison of hematologic parameters between the two groups showed a significantly lower CALLY index in the "deceased" group (3.05 (4.92)) compared to the "survivor" group (10.13 (13.69)) (p < 0.001). The study compared the parameters between groups with regard to in-hospital mortality.

CONCLUSIONS

Based on the results of the study, we conclude that the CALLY index can be considered an easily applicable indicator for the mortality of glioblastoma patients.

Albumin-Lymphocyte-Globulin-C-Reactive Protein Index as a Novel Prognostic Biomarker for Hepatocellular Carcinoma after Hepatectomy

INTRODUCTION

This study evaluated the performance of the albumin-lymphocyte-globulin-C-reactive protein (CRP) (ALGC) index as a novel prognostic biomarker for hepatocellular carcinoma (HCC) after hepatectomy.

METHODS

Patients (n = 178) who underwent hepatectomy for HCC (July 2010-December 2021) were analyzed. The ALGC index was calculated as ([albumin × lymphocyte]/[CRP × globulin × 104]). Patients were divided into a low ALGC group (<1.82; n = 81) and a high ALGC group (≥1.82; n = 97). The association of the ALGC index with survival was assessed by univariate and multivariate analyses.

RESULTS

The median overall survival (OS) was 100 (range: 1-149) months with 1-, 3-, and 5-year OS rates of 91.6%, 81.2%, and 64.2%, respectively. In univariate analysis, ALGC index (<1.82), alpha-fetoprotein (≥25 ng/mL), tumor size (≥3.5 cm), microvascular invasion, and multiple tumors were associated with shorter OS. ALGC index (<1.82) (hazard ratio [95% confidence interval]) (2.48 [1.407-4.513]; p = 0.001) and multiple tumors (1.92 [1.070-3.356]; p = 0.029) were independent predictors of OS in multivariate analysis.

CONCLUSION

ALGC index is a novel prognostic biomarker for HCC after hepatectomy. It may assist in treatment stratification and better management of patients with HCC.

Clinical feasibility of the preoperative C-reactive protein-albumin-lymphocyte index to predict short- and long-term outcomes of patients with gastric cancer

BACKGROUND

Gastric cancer (GC) is a major leading cause of cancer-related death worldwide. Systemic inflammation and the nutrition-based score are feasible prognostic markers for malignancies. Emerging evidence has also revealed the C-reactive protein-albumin-lymphocyte (CALLY) index to be a prognostic marker for several cancer types. However, its clinical significance to predict surgical and oncologic outcomes of patients with GC remains unclear.

METHODS

We assessed the preoperative CALLY index in 426 patients with GC who received gastrectomy.

RESULTS

A low preoperative CALLY index was significantly correlated to all well-established clinicopathologic factors for disease development, including an advanced T stage, the presence of venous invasion, lymphatic vessel invasion, lymph node metastasis, distant metastasis, and an advanced TNM stage. A low preoperative CALLY index was also an independent prognostic factor for overall survival (hazard ratio [HR], 2.64; 95 % CI, 1.66-4.2; P < .0001) and disease-free survival (HR, 1.76; 95 % CI, 1.01-3.05; P = .045). In addition, a low preoperative CALLY index was an independent predictive factor for postoperative surgical site infection (odds ratio, 2.64; 95 % CI, 1.42-4.89; P = .002).

CONCLUSION

The preoperative CALLY index is valuable for perioperative and oncologic management of patients with GC.

Predictive values of sarcopenia and systemic inflammation-based markers in advanced hepatocellular carcinoma after hepatectomy

BACKGROUND

Sarcopenia accompanied by systemic inflammation is associated with poor prognosis in patients with advanced hepatocellular carcinoma (HCC). However, the effect of sarcopenia combined with systemic inflammation on the prognosis of patients with advanced HCC who underwent hepatectomy is unclear. This study aimed to evaluate the effect of sarcopenia and inflammation on the prognosis of patients with advanced HCC.

METHODS

This retrospective study included 151 patients recruited between July 2010 and December 2022. We defined advanced HCC as that presenting with vascular invasion or tumor size ≥2 cm or multiple tumors. Sarcopenia was assessed using the psoas muscle index. Preoperative inflammatory markers were used by calculating the prognostic nutritional index, albumin-globulin ratio (AGR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio. Cox regression analysis was performed to determine the prognostic factors for overall survival.

RESULTS

Of 151 patients, sarcopenia occurred in 84 (55.6 %). Sarcopenia was significantly associated with male sex, older age, body mass index (<25 kg/m2), and a higher NLR. In the multivariate analysis, AGR <1.25 (hazard ratio [HR], 2.504; 95% confidence interval [CI]: 1.325-4.820; p < 0.05); alpha-fetoprotein levels ≥25 ng/mL (HR, 1.891; 95% CI: 1.016-3.480; p = 0.04); and sarcopenia (HR, 1.908; 95% CI: 1.009-3.776; p < 0.05) were independent predictors of overall survival. The sarcopenia and low AGR groups had significantly worse overall survival than either the non-sarcopenia and high AGR or sarcopenia and low AGR groups.

CONCLUSION

Sarcopenia and AGR are independent prognostic factors in patients with advanced HCC. Thus, sarcopenia may achieve a better prognostic value when combined with AGR.

What is a useful marker for predicting survival in patients with high-grade soft tissue sarcoma who have non-inflammatory conditions?

BACKGROUND

The modified Glasgow prognostic score (mGPS) is a reliable system for identifying patients at high risk of death among patients with soft tissue sarcoma (STS). The scoring systems use a combination of C-reactive protein (CRP) and albumin levels. Although patients with high-grade STS are at risk of metastasis and death, even if their mGPS is 0, the prognostic indicators in these patients are unknown. Therefore, we investigated useful prognostic indicators for survival and the development of metastasis in patients with high-grade STS and an mGPS of 0.

METHODS

One hundred and four patients with CRP and albumin levels of <1.0 mg/dl and >3.5 g/dl, respectively, indicating an mGPS of 0, were included. The mean follow-up period was 79 months.

RESULTS

The 5-year disease-specific survival (DSS) rate was 79.2%. Cox proportional analysis showed that tumor size and absolute neutrophil count (ANC) were prognostic variables in multivariate analyses. Patients with higher ANC (ANC>3370/μl) had a worse DSS than those with lower ANC. The 5-year DSS was 74.7% vs. 91.7%, respectively (p = 0.0207). The 5-year metastasis-free survival was 67.2%. Tumor size and ANC remained significant variables for predicting the development of metastasis in the multivariate analysis. Patients with higher ANC had a worse metastasis-free survival than those with lower ANC. The 5-year metastasis-free survival was 59.5% vs. 87.3%, respectively (p = 0.00269).

CONCLUSIONS

When patients with high-grade STS have an mGPS of 0, the ANC and tumor size should be carefully evaluated. A higher neutrophil count and larger tumor size may increase the risk of metastasis development.

Significance of Pre-Treatment CALLY Score Combined with EBV-DNA Levels for Prognostication in Non-Metastatic Nasopharyngeal Cancer Patients: A Clinical Perspective

Background

The C-reactive protein-albumin-lymphocyte (CALLY) score is a novel indicator associated with inflammation, immunity, and nutrition, utilized for cancer prognostic stratification. This study aimed to evaluate the integrated prognostic significance of the pre-treatment CALLY score and Epstein-Barr virus (EBV) DNA levels in nasopharyngeal carcinoma (NPC) patients and to develop prognostic models.

Patients and Methods

A total of 1707 NPC patients from September 2015 to December 2017 were retrospectively enrolled. The cut-off point for the CALLY score, determined by maximum selected rank statistics, integrates with the published cut-off point for pre-EBV DNA to develop a comprehensive index. Subsequently, patients were randomly allocated in a 1:1 ratio into training and validation cohorts. Survival analysis was conducted using the Kaplan-Meier method with Log rank tests, and the Cox proportional hazards model was applied to identify independent prognostic factors for constructing predictive nomograms. The predictive ability of the nomograms were assessed through the concordance index (C-index), calibration curves, and decision curve analysis.

Results

By integrating CALLY scores and EBV-DNA levels, patients were categorized into three risk clusters. Kaplan-Meier curves reveal significant differences in overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) outcomes among different risk groups (all P values < 0.05). Multivariate analysis revealed that CALLY-EBV DNA index serves as an independent prognostic factor for the OS, DMFS, and LRRFS. The prognostic nomograms based on the CALLY-EBV DNA index provided accurate predictions for 1-year, 3-year, and 5-year OS, DMFS, and LRRFS. Additionally, compared to the traditional TNM staging system, the nomograms exhibited enhanced discriminatory power, calibration capability, and clinical applicability. All results were in agreement with the validation cohort.

Conclusion

The CALLY-EBV DNA index is an independent prognostic biomarker. The nomogram prediction models, constructed based on the CALLY-EBV DNA index, demonstrates superior predictive performance compared to the traditional TNM staging.

Clinical predictive value of the CRP-albumin-lymphocyte index for prognosis of critically ill patients with sepsis in intensive care unit: a retrospective single-center observational study

Background

Sepsis is a complex syndrome characterized by physiological, pathological, and biochemical abnormalities caused by infection. Its development is influenced by factors such as inflammation, nutrition, and immune status. Therefore, we combined C-reactive protein (CRP), albumin, and lymphocyte, which could reflect above status, to be the CRP-albumin-lymphocyte (CALLY) index, and investigated its association with clinical prognosis of critically ill patients with sepsis.

Methods

This retrospective observational study enrolled critically ill patients with sepsis who had an initial CRP, albumin, and lymphocyte data on the first day of ICU admission. All data were obtained from the Affiliated Hospital of Jiangsu University. The patients were divided into quartiles (Q1-Q4) based on their CALLY index. The outcomes included 30-/60-day mortality and acute kidney injury (AKI) occurrence. The association between the CALLY index and these clinical outcomes in critically ill patients with sepsis was evaluated using Cox proportional hazards and logistic regression analysis.

Results

A total of 1,123 patients (63.0% male) were included in the study. The 30-day and 60-day mortality rates were found to be 28.1 and 33.4%, respectively, while the incidence of AKI was 45.6%. Kaplan-Meier analysis revealed a significant association between higher CALLY index and lower risk of 30-day and 60-day mortality (log-rank p < 0.001). Multivariate Cox proportional hazards analysis indicated that the CALLY index was independently associated with 30-day mortality [HR (95%CI): 0.965 (0.935-0.997); p = 0.030] and 60-day mortality [HR (95%CI): 0.969 (0.941-0.997); p = 0.032]. Additionally, the multivariate logistic regression model showed that the CALLY index served as an independent risk predictor for AKI occurrence [OR (95%CI): 0.982 (0.962-0.998); p = 0.033].

Conclusion

The findings of this study indicated a significant association between the CALLY index and both 30-day and 60-day mortality, as well as the occurrence of AKI, in critically ill patients with sepsis. These findings suggested that the CALLY index may be a valuable tool in identifying sepsis patients who were at high risk for unfavorable outcomes.

DGPRI, a new liver fibrosis assessment index, predicts recurrence of AFP-negative hepatocellular carcinoma after hepatic resection: a single-center retrospective study

Although patients with alpha-fetoprotein-negative hepatocellular carcinoma (AFPNHCC) have a favorable prognosis, a high risk of postoperative recurrence remains. We developed and validated a novel liver fibrosis assessment index, the direct bilirubin-gamma-glutamyl transpeptidase-to-platelet ratio (DGPRI). DGPRI was calculated for each of the 378 patients with AFPNHCC who underwent hepatic resection. The patients were divided into high- and low-score groups using the optimal cutoff value. The Lasso-Cox method was used to identify the characteristics of postoperative recurrence, followed by multivariate Cox regression analysis to determine the independent risk factors associated with recurrence. A nomogram model incorporating the DGPRI was developed and validated. High DGPRI was identified as an independent risk factor (hazard ratio = 2.086) for postoperative recurrence in patients with AFPNHCC. DGPRI exhibited better predictive ability for recurrence 1-5 years after surgery than direct bilirubin and the gamma-glutamyl transpeptidase-to-platelet ratio. The DGPRI-nomogram model demonstrated good predictive ability, with a C-index of 0.674 (95% CI 0.621-0.727). The calibration curves and clinical decision analysis demonstrated its clinical utility. The DGPRI nomogram model performed better than the TNM and BCLC staging systems for predicting recurrence-free survival. DGPRI is a novel and effective predictor of postoperative recurrence in patients with AFPNHCC and provides a superior assessment of preoperative liver fibrosis.