The C-reactive protein–albumin–lymphocyte (CALLY) index in early hospital presentation and intravenous thrombolysis in acute ischemic stroke

Q: What are the key findings of this study?

Admission ln(CALLY) had an inconsistent borderline association with early stroke presentation and no association with thrombolysis receipt.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=197). Intervention: Admission C-reactive protein–albumin–lymphocyte (CALLY) index [ln(CALLY)] vs. Lower CALLY index (continuous per 1-unit increase in ln(CALLY)). Primary outcome: Early hospital presentation (onset-to-door time ≤4.5 hours) (OR 1.34, 95% CI 1.02–1.77, p=0.036).

Q: What does this research mean for the field?

The CALLY index is not consistently or independently associated with early hospital presentation or receipt of intravenous thrombolysis in acute ischemic stroke, with lower values largely explained by baseline stroke severity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ayşe Fethiye Basa Kalafat; Muhammed Güner; Elif Gizem Olcay; Feyza Karadeniz; Bilal Yeniyurt; Salih Fettahoğlu; Rabia Birsen Tapkan; Hilmi Kaya; Süreyya Tuba Fettahoğlu; Utku Murat Kalafat

doi:10.1097/md.0000000000051419

October 30, 2026Open Access

The C-reactive protein–albumin–lymphocyte (CALLY) index in early hospital presentation and intravenous thrombolysis in acute ischemic stroke

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Key result

Higher admission CALLY index is linked to ~34% higher odds of early stroke presentation.

OR 1.34
95% CI 1.02–1.77
P=0.036
n=197

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Why the study?

The C-reactive protein-albumin-lymphocyte (CALLY) index reflects systemic inflammation and immune and nutritional status, but whether admission CALLY is associated with early hospital presentation or receipt of intravenous thrombolysis in adults with acute ischemic stroke was uncertain.

Is the admission C-reactive protein–albumin–lymphocyte (CALLY) index associated with early hospital presentation (≤4.5 hours) or receipt of intravenous thrombolysis in adults with acute ischemic stroke?

Key Points

To evaluate whether admission C-reactive protein–albumin–lymphocyte (CALLY) index is associated with early hospital presentation within 4.5 hours or receipt of intravenous thrombolysis in adults with acute ischemic stroke.
Single-center retrospective study of 197 adults with acute ischemic stroke admitted between September 2018 and September 2024, comparing 98 patients receiving intravenous thrombolysis against 99 group-matched non-thrombolyzed controls.
CALLY index was calculated as albumin (g/L) × lymphocyte count (×10^9/L) / [C-reactive protein (mg/L) × 10].
Multivariable logistic regression adjusted for age, sex, and National Institutes of Health Stroke Scale (NIHSS) score to evaluate associations with early presentation and thrombolysis.
Patients receiving thrombolysis had higher NIHSS scores (median, 7 vs 1; P < .001) and lower CALLY values (median, 1.37 vs 2.64; P = .050), though the CALLY difference was nonsignificant after multiplicity correction (q = 0.122).
After adjustment for age, sex, and NIHSS score, ln(CALLY) was not associated with receipt of thrombolysis (adjusted OR = 1.34; 95% CI = 0.98–1.82; P = .063) and showed a borderline association with early presentation (adjusted OR = 1.34; 95% CI = 1.02–1.77; P = .036) that was inconsistent across sensitivity analyses.
CALLY index did not differ significantly between early (≤4.5 hours) and late presenters (median, 1.45 vs 2.93; P = .100) and correlated inversely with baseline NIHSS score (Spearman ρ = −0.29; P < .001).

Study Design

Type

Observational (n=197)

Multicenter

No

Structured PICO

Is the admission C-reactive protein–albumin–lymphocyte (CALLY) index associated with early hospital presentation (≤4.5 hours) or receipt of intravenous thrombolysis in adults with acute ischemic stroke?

P

Population

197 adults (mean age 65.6 years, 42.1% female) presenting with acute ischemic stroke (98 treated with intravenous thrombolysis and 99 frequency-matched controls), excluding those with active infection, malignancy, or immunosuppression, followed for 30 days.

E

Exposure

Admission C-reactive protein–albumin–lymphocyte (CALLY) index, calculated as [albumin (g/L) × lymphocyte count (×10^9/L)] / [CRP (mg/L) × 10] (evaluated as natural log-transformed ln(CALLY) in regression models); in the thrombolytic group (n=98), patients received intravenous alteplase 0.9 mg/kg (maximum 90 mg, 10% initial bolus and remainder infused over 60 minutes) within 4.5 hours of symptom onset.

C

Comparator

Non-thrombolytic control group (n=99) who did not receive intravenous thrombolysis (81 arrived >4.5 hours after symptom onset; 18 arrived ≤4.5 hours but were not treated due to mild/non-disabling deficit [n=16] or relative contraindications [n=2]), selected via 1:1 group-level frequency matching.

O

Outcome

Early hospital presentation, defined as an onset-to-door time (time from symptom onset to emergency department arrival) of ≤4.5 hours

Main Result

Odds Ratio: 1.34 (95% CI 1.02–1.77)

p-value: p=0.036

In patients with acute ischemic stroke, admission CALLY index values were inversely correlated with stroke severity (NIHSS) and showed no consistent independent association with early hospital arrival or receipt of intravenous thrombolysis, indicating CALLY should not be used to guide thrombolytic decision-making.

Limitations

Retrospective, single-center design limiting generalizability
Control group selected by frequency matching and random selection rather than consecutively, leaving residual imbalances and potential selection bias
Missing data on several relevant clinical and imaging variables (e.g., blood pressure, atrial fibrillation, pre-stroke mRS, ASPECTS, large-vessel occlusion)
Reasons for nontreatment among early presenters were obtained retrospectively from medical records
No a priori sample size calculation and underpowered 30-day mortality comparison due to very few events
Laboratory parameters assessed only once at admission without serial measurements
Regression and sensitivity analysis P values were not adjusted for multiplicity
Single-center, retrospective, observational design
No a priori sample size calculation was performed
P values from regression and sensitivity analyses were not adjusted for multiplicity, making findings exploratory
Residual baseline imbalance in age between groups (SMD 0.21) despite group-level frequency matching
Small number of mortality events (3 deaths) and non-thrombolyzed early presenters (n=18)

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Implication

No consistent link to early arrival or IVT receipt; leaves open CALLY's role beyond stroke severity correlation.

Abstract

The C-reactive protein–albumin–lymphocyte (CALLY) index reflects systemic inflammation and immune and nutritional status. We investigated whether admission CALLY was associated with early hospital presentation or receipt of intravenous thrombolysis (IVT) in adults with acute ischemic stroke. This single-center retrospective study included 197 adults with acute ischemic stroke admitted between September 2018 and September 2024. All 98 patients who received IVT were included; 99 non-thrombolyzed controls were selected by computer-generated random sampling from a pool constructed using group-level frequency matching. CALLY was calculated as albumin (g/L) × lymphocyte count (×10(9)/L)/[C-reactive protein (mg/L) × 10]. Early presentation was defined as onset-to-door time ≤4.5 hours. Multivariable logistic regression adjusted for age, sex, and National Institutes of Health Stroke Scale (NIHSS) score assessed associations of ln(CALLY) with early presentation and receipt of IVT. Patients who received IVT had higher NIHSS scores (median, 7 vs 1; P < .001) and lower CALLY values (median, 1.37 vs 2.64; P = .050); however, the CALLY difference was not significant after multiplicity correction (q = 0.122). CALLY was inversely correlated with NIHSS score (Spearman ρ = −0.29; P < .001). After adjustment, ln(CALLY) was not associated with receipt of IVT (adjusted odds ratio = 1.34; 95% confidence interval = 0.98–1.82; P = .063). Its borderline association with early presentation (adjusted odds ratio = 1.34; 95% confidence interval = 1.02–1.77; P = .036) was not consistent across sensitivity analyses. CALLY did not differ significantly between early and late presenters (P = .100). Lower CALLY values among patients receiving IVT were largely explained by greater stroke severity. No consistent independent association was found between CALLY and either outcome. These findings do not support using CALLY to guide thrombolytic decision-making.

Discussion

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Cite This Study

Kalafat et al. (2026) conducted an observational in Acute ischemic stroke (n=197). Admission C-reactive protein–albumin–lymphocyte (CALLY) index [ln(CALLY)] vs. Lower CALLY index (continuous per 1-unit increase in ln(CALLY)) was evaluated on Early hospital presentation (onset-to-door time ≤4.5 hours) (OR 1.34, 95% CI 1.02–1.77, p=0.036). Admission ln(CALLY) had an inconsistent borderline association with early stroke presentation and no association with thrombolysis receipt.

synapsesocial.com/papers/6aee6bc771a7594806220b5f https://doi.org/10.1097/md.0000000000051419

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The C-reactive protein–albumin–lymphocyte (CALLY) index in early hospital presentation and intravenous thrombolysis in acute ischemic stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The C-reactive protein–albumin–lymphocyte (CALLY) index in early hospital presentation and intravenous thrombolysis in acute ischemic stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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