What question did this study set out to answer?

This study aims to evaluate the prognostic value of the CALLY index for predicting 30-day mortality in patients with Fournier gangrene.

February 2, 2026

CALLY Index as a Prognostic Marker for 30-Day Mortality in Fournier Gangrene: A Multicenter Retrospective Cohort Study

Key Points

This study aims to evaluate the prognostic value of the CALLY index for predicting 30-day mortality in patients with Fournier gangrene.
Multicenter retrospective cohort study
Included 136 adults who underwent surgical treatment for Fournier gangrene
Analyzed demographic variables, comorbidities, laboratory parameters, and outcomes
30-day mortality rate was 17% among study participants
Non-survivors had lower albumin and lymphocyte levels, and higher CRP levels
CALLY index showed strong predictive capability for 30-day mortality with AUC of 0.886
CALLY cutoff ≤0.012 achieved 82.6% sensitivity and 95.6% specificity
CALLY index and qSOFA score were identified as strong independent mortality predictors

Abstract

Background Fournier gangrene (FG) remains a life-threatening necrotizing infection with persistently high mortality despite advances in surgical and supportive care. Reliable early prognostic markers are therefore essential. The C-reactive protein–albumin–lymphocyte (CALLY) index, which integrates inflammatory, nutritional, and immune status, has shown prognostic value in several critical illness settings, but its utility in FG has not been adequately evaluated. Methods This multicenter retrospective cohort study included 136 adults who underwent surgical treatment for FG between 2015 and 2025. Demographic variables, comorbidities, laboratory parameters, qSOFA scores, and 30-day outcomes were analyzed. Results The 30-day mortality rate was 17% (23/136). Non-survivors had significantly lower albumin and lymphocyte levels, higher CRP levels, and markedly reduced CALLY indices compared with survivors (0.005 vs 0.039, P < 0.001). The CALLY index demonstrated strong discriminative performance for 30-day mortality (AUC = 0.886; 95% CI: 0.780-0.991). A cutoff ≤0.012 provided 82.6% sensitivity and 95.6% specificity. In multivariate analysis, CALLY ≤0.012 (OR 42.61; P < 0.001) and qSOFA score 2-3 (OR 12.97; P = 0.019) emerged as strong independent predictors of mortality, whereas age, sex, uncontrolled diabetes, CAD, immunosuppression, and malignancy were not independently associated with death. Discussion The C-reactive protein–albumin–lymphocyte (CALLY) index was independently associated with 30-day mortality in patients with Fournier gangrene and may serve as a simple adjunctive biomarker for early risk stratification when interpreted alongside established clinical scoring systems such as qSOFA. Incorporating the CALLY index into early risk-stratification algorithms may facilitate timely clinical decision-making and more targeted management strategies for high-risk FG patients.

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