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A higher C-reactive protein–albumin–lymphocyte (CALLY) index is associated with 64% lower all-cause mortality and 67% lower cardiovascular mortality in adults with chronic inflammatory airway diseases.
A population-based analysis suggests that the CALLY index is inversely associated with all-cause and cardiovascular (CV) mortality among U.S. adults with chronic inflammatory airway diseases. The association remained evident after adjustment for multiple potential confounding factors.
Why was this association studied?
Chronic inflammatory airway diseases (CIADs) are associated with systemic inflammation and may coexist with nutritional and immune alterations that influence long-term outcomes. Because routine laboratory measures can reflect different aspects of inflammation and nutritional status, composite indices have been investigated for their potential prognostic value.
The C-reactive protein–albumin–lymphocyte (CALLY) index combines C-reactive protein (CRP), serum albumin, and lymphocyte count into a single measure. By integrating inflammatory, nutritional, and immune-related parameters, the index may provide information that is not captured by any one component alone.
Researchers therefore examined whether CALLY index levels were associated with subsequent mortality among adults with CIADs.
What did the study examine?
The analysis included 4,128 U.S. adults with CIADs identified using National Health and Nutrition Examination Survey (NHANES) 1999–2010. CALLY index values were assessed at baseline and categorized into quartiles. Mortality outcomes were subsequently evaluated through population-based follow-up. The primary outcomes were CV mortality and all-cause mortality.
Importantly, the analysis employed the baseline CALLY index rather than repeated measurements over time. Therefore, the study evaluated whether the initial CALLY level was associated with later mortality rather than whether changes in CALLY were associated with changes in risk.
Higher CALLY levels showed an inverse association with mortality
Participants with higher CALLY index levels had lower mortality during follow-up compared with those in the lowest CALLY category. In the fully adjusted analysis, the highest CALLY quartile was linked with a 64% lower relative risk of all-cause mortality and a 67% lower relative risk of CV mortality compared with the lowest quartile.
The association remained after multivariable adjustment
Researchers used weighted Cox proportional hazards regression to evaluate the relationship between CALLY index categories and mortality. After adjustment for multiple covariates in Model 3, the inverse link remained significant. For all-cause mortality, the hazard ratio for volunteers in the highest quartile vs. the lowest quartile was 0.36. For CV mortality, the corresponding hazard ratio was 0.33.
Restricted cubic spline analyses were additionally performed to investigate potential nonlinear relationships between the CALLY index and mortality. Subgroup and sensitivity analyses were also executed to examine the robustness of the observed links.
What does the CALLY index represent?
The CALLY index incorporates three routinely available laboratory parameters:
The composite nature of the index allows these parameters to be considered together rather than individually. The observed associations suggest that CALLY may capture information relevant to mortality risk in CIADs. However, the analysis does not establish that the CALLY index itself causes changes in mortality.
Clinical implications
By combining lymphocyte counts, serum albumin, and CRP levels into a single metric, the CALLY index offers clinicians an accessible, multi-dimensional tool for risk stratification and prognosis management in pulmonary care.
Mediators of Inflammation
Elevated C-Reactive Protein–Albumin–Lymphocyte Index Is Associated With Reduced Mortality in Chronic Inflammatory Airway Diseases: A Population-Based Observational Study
Yuting Fan et al.
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