Prognostic Value of the C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage: A Comparative Analysis with Hematoma Volume

Purpose: The C-reactive protein–albumin–lymphocyte (CALLY) index is a composite biomarker reflecting systemic inflammation, nutritional status, and immune response. Its role in predicting mortality in spontaneous intracerebral hemorrhage (ICH) remains unclear. This study aimed to evaluate the prognostic performance of the CALLY index for in-hospital mortality in patients with spontaneous ICH and to compare it with hematoma volume. Methods: This retrospective study included 74 patients diagnosed with spontaneous intracerebral hemorrhage. Demographic, clinical, laboratory, and radiological data were analyzed. The CALLY index was calculated using admission serum albumin, C-reactive protein (CRP), and lymphocyte count. The predictive performance of the CALLY index and hematoma volume for in-hospital mortality was assessed using receiver operating characteristic (ROC) curve analysis. Optimal cutoff values were determined by the Youden index. The discriminative abilities of the models were compared using the DeLong test. Incremental prognostic value was evaluated using Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) analyses. Results: In-hospital mortality occurred in 27% of the patients. CALLY index values were significantly lower in non-survivors compared to survivors (p=0.015), while hematoma volume was significantly higher in non-survivors (p=0.017). The CALLY index demonstrated moderate discriminative performance for predicting mortality (AUC: 0.668; p=0.015), with an optimal cutoff value of 0.36 (sensitivity 65%, specificity 69%). Hematoma volume also showed moderate predictive ability (AUC: 0.682; p=0.017), with an optimal cutoff value of 21 cc (sensitivity 70%, specificity 67%). No statistically significant difference was observed between the two models (ΔAUC=0.004; p=1.000). Reclassification analyses indicated minimal incremental prognostic contribution of the CALLY index (NRI=0.006; IDI=− 0.016). Conclusion: Both the CALLY index and hematoma volume demonstrated moderate and comparable performance in predicting in-hospital mortality in spontaneous ICH. However, the CALLY index did not provide significant additional prognostic value beyond hematoma volume. Larger prospective studies are warranted to clarify the role of inflammation-based biomarkers in hemorrhagic stroke prognosis.