[Correlation between the C-reactive protein-albumin-lymphocyte count index and the 90-day prognosis of patients with acute ischemic stroke undergoing reperfusion therapy].

Authors

Qiongdan Hu, Shanshan Xu, Xia Chen

Published in

Zhonghua wei zhong bing ji jiu yi xue. Volume 38. Issue 5. Pages 536-543.

Abstract

To investigate the correlation between the C-reactive protein-albumin-lymphocyte count (CALLY) index and the 90-day prognosis of patients with acute ischemic stroke (AIS) undergoing reperfusion therapy, and to clarify its predictive value for the 90-day prognosis of these patients.
A single-center retrospective case-control study was conducted. Patients with AIS who received reperfusion therapy in the Department of Neurology, the First Affiliated Hospital of the University of Science and Technology of China, from January 1, 2022, to August 31, 2025, were enrolled as the research subjects. Baseline clinical data, including demographic characteristics, medical history, pre-reperfusion National Institutes of Health Stroke Scale (NIHSS) score, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, type of reperfusion therapy, and length of hospital stay, as well as laboratory indicators including C-reactive protein (CRP), white blood cell count (WBC), lymphocyte count (LYM), neutrophil count (NEU), and albumin (Alb) measured within 24 hours after symptom onset, were retrospectively collected from the hospital's electronic medical record system. The CALLY index was calculated accordingly. The 90-day modified Rankin Scale (mRS) score after onset was defined as the primary outcome. All enrolled patients were stratified into the good prognosis group (mRS score: 0-2) and the poor prognosis group (mRS score: 3-6). Baseline clinical and laboratory variables were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to explore the association between the CALLY index and 90-day poor prognosis in AIS patients. A restricted cubic spline (RCS) model was applied to analyze the dose-response relationship between the CALLY index and the risk of poor prognosis. Receiver operator characteristic curve (ROC curve) analysis was used to evaluate the predictive efficacy of the CALLY index alone and in combination with other indicators for 90-day poor prognosis in patients with AIS.
Finally, a total of 1 253 AIS patients who received reperfusion therapy were enrolled in this study, including 759 patients in the good prognosis group and 494 patients in the poor prognosis group. Baseline analysis showed significant differences between the two groups in age, history of hyperlipidemia, history of atrial fibrillation, pre-reperfusion NIHSS score, TOAST classification, treatment type, length of hospital stay, and levels of CRP, WBC, LYM, NEU, and Alb, as well as the CALLY index (all P<0.05). Univariate and multivariate logistic regression analyses revealed that the CALLY index was significantly negatively correlated with 90-day poor prognosis in AIS patients (all P<0.05). After adjusting for confounding factors including gender, age, and previous medical history, each 1-unit increase in the CALLY index reduced the risk of 90-day poor prognosis in AIS patients by 4.2% [odds ratio (OR) = 0.958, 95% confidence interval (95%CI) was 0.937-0.980, P<0.001], indicating that the CALLY index was an independent protective factor against poor 90-day prognosis in AIS patients. The RCS model confirmed a significant nonlinear negative correlation between the CALLY index and 90-day poor prognosis (nonlinear P<0.001), with an optimal cutoff value of 2.242. Patients with a CALLY index below this cutoff value had a significantly higher risk of poor prognosis. ROC curve analysis demonstrated that the AUC of the single CALLY index for predicting 90-day poor prognosis was 0.630 (95%CI was 0.598-0.661). The binary logistic regression prediction model established by combining the CALLY index with age and pre-reperfusion NIHSS score yielded an increased AUC of 0.823 (95%CI was 0.800-0.846), with an optimal cutoff value of 0.322, a sensitivity of 68.2%, a specificity of 82.6%, and a predictive accuracy of 73.9%. Based on the RCS-derived cutoff value of 2.242 for the CALLY index, all enrolled patients were divided into the low CALLY index group (CALLY index<2.242, 627 cases) and the high CALLY index group (CALLY index≥2.242, 626 cases). Significant differences existed between the two groups in age, history of hyperlipidemia, history of atrial fibrillation, pre-reperfusion NIHSS score, TOAST classification, reperfusion therapy type, length of hospital stay, CRP, WBC, LYM, NEU, Alb, and 90-day mRS score (all P<0.05). Moreover, the low CALLY index group had a significantly higher 90-day mortality rate than the high CALLY index group [19.14% (120/627) vs. 11.82% (74/626), P<0.05].
The CALLY index serves as an independent protective factor for the 90-day prognostic outcome in AIS patients receiving reperfusion therapy. The combined prediction model incorporating the CALLY index, age, and pre-reperfusion NIHSS score exhibits superior predictive efficacy for clinical prognosis.

PMID:
42427326
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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