A Correlational Study on CALLY Index as a Potential Predictive Indicator for Postoperative in-Hospital Mortality in Acute Aortic Dissection Patients

Objective: Acute Type A Aortic Dissection (ATAAD) is a highly lethal cardiovascular emergency characterized by persistently high postoperative in-hospital mortality (POIM), which necessitates effective preoperative risk assessment tools. This study aimed to investigate the predictive value of the preoperative CRP-albumin-lymphocyte (CALLY) index for POIM in ATAAD patients and to construct a corresponding nomogram model. Methods: This retrospective study enrolled 522 surgically treated ATAAD patients admitted to Fujian Medical University Union Hospital between October 2015 and July 2024, with POIM designated as the study endpoint. Univariate and multivariate logistic regression analyses were performed to identify predictors of POIM,and LASSO regression was subsequently used to develop a predictive model. Results: This study included a total of 522 patients. The results demonstrated that the preoperative CALLY index was an independent protective factor for POIM (OR=0.131, 95% CI:0.110– 0.199), and its predictive performance (AUC=0.820) was superior to that of individual parameters such as lymphocyte count, albumin, and CRP. Patients with lower CALLY index had significantly higher incidences of postoperative gastrointestinal hemorrhage, acute kidney injury, and POIM ( P < 0.05). The nomogram model integrating pre-hospital emergency care, prothrombin time, urea, creatine kinase, troponin I, lactate, and CALLY index showed good predictive performance (AUC=0.843). Internal and external validations yielded robust AUCs of 0.849 and 0.869, respectively, with Hosmer-Lemeshow tests confirming good fit ( P > 0.05).Subgroup analysis revealed that the predictive value of the CALLY index was consistent across different clinical subgroups. Conclusion: The preoperative CALLY index demonstrates significant predictive efficacy for POIM in ATAAD patients. The developed nomogram model, incorporating the CALLY index, provides a practical tool for optimizing perioperative decision-making.