Prognostic significance of the CALLY index for mortality among patients with cardiovascular–kidney–metabolic syndrome stages 0–3

Q: What does this research mean for the field?

A higher C-reactive protein-albumin-lymphocyte (CALLY) index is independently associated with reduced all-cause and cardiovascular mortality in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shuaiqing Chen; Jing Ye; Xiaohan Hu

doi:10.1186/s13098-025-02068-x

December 16, 2025Diabetology & Metabolic SyndromeOpen Access

Prognostic significance of the CALLY index for mortality among patients with cardiovascular–kidney–metabolic syndrome stages 0–3

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Why the study?

The association between the C-reactive protein-albumin-lymphocyte (CALLY) index and mortality risk among individuals in stages 0 to 3 of cardiovascular-kidney-metabolic syndrome remains poorly defined.

Does the CALLY index predict all-cause and cardiovascular mortality in individuals with stage 0-3 cardiovascular-kidney-metabolic syndrome?

Structured PICO

Does the CALLY index predict all-cause and cardiovascular mortality in individuals with stage 0-3 cardiovascular-kidney-metabolic syndrome?

P

Population

9,886 individuals with stage 0-3 cardiovascular-kidney-metabolic (CKM) syndrome from NHANES

I

Intervention

CALLY index (C-reactive protein-albumin-lymphocyte index) measurement

C

Comparator

Lower CALLY index (e.g., bottom tertile)

O

Outcome

All-cause mortality and cardiovascular mortalityhard clinical

The CALLY index is a potential prognostic biomarker, with higher levels inversely associated with all-cause and cardiovascular mortality in patients with stage 0-3 CKM syndrome.

Implication

May aid mortality risk assessment in early CKM syndrome; hypothesis-generating and requires prospective validation.

Abstract

BACKGROUND: The C-reactive protein-albumin-lymphocyte (CALLY) index integrates inflammation, nutrition, and immune status, serving as a novel, cost-effective biomarker. However, its association with mortality risk among individuals in stages 0 to 3 of the cardiovascular-kidney-metabolic (CKM) syndrome remains poorly defined. METHODS: Data from 9,886 individuals with stage 0-3 CKM syndrome in NHANES were examined. Cox proportional hazards regression, accounting for various covariates, was employed to examine the association between ln CALLY and mortality. RCS and threshold analysis were applied to investigate possible non-linear associations. Survival distributions were visualized using Kaplan-Meier curves, and additional analyses included time-dependent ROC analyses, subgroup analyses, and interaction tests. RESULTS: A strong inverse relationship was observed between ln CALLY and both all-cause mortality (HR = 0.86, 95% CI: 0.82-0.89) and cardiovascular mortality (HR = 0.81, 95% CI: 0.75-0.89). Participants in the top tertile of ln CALLY showed a 34% reduction in all-cause mortality and a 37% decline in cardiovascular mortality relative to the bottom tertile. RCS indicated a distinct L-shaped curve linking ln CALLY with all-cause mortality. Across multiple subgroups, the relationships remained stable, with no meaningful interaction effects identified. CONCLUSIONS: This analysis demonstrates that the CALLY index is inversely related to mortality in CKM stage 0-3 patients, indicating its value as a potential biomarker for early prognosis assessment.