Systematic review and meta-analysis of CALLY index in sepsis patients
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Key Takeaway
Note variable CALLY index performance across ethnic groups in sepsis.
This systematic review and meta-analysis examined the CALLY index in 3,848 patients with sepsis to determine its diagnostic accuracy and association with mortality. The study compared survivors versus non-survivors to evaluate the index performance across different cohorts.
In Chinese cohorts, a higher CALLY index correlated with survival with a standardized mean difference of -1.04 and a 95% CI of -1.69 to -0.39. Conversely, the Turkish cohort showed an association with mortality, with an SMD of 1.39 and a 95% CI of 1.02 to 1.75. Overall, the difference in the CALLY index between survivors and non-survivors did not significantly differ with an SMD of -0.22 and a 95% CI of -1.18 to 0.74.
Diagnostic accuracy for predicting mortality was moderate, with a sensitivity of 0.59 and a specificity of 0.77. The authors noted significant heterogeneity was observed across all pooled analyses. The variable link to mortality across ethnic groups requires validation in large, multinational prospective studies before widespread clinical adoption.
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View Original Abstract ↓
BackgroundThe C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker of inflammation, nutrition, and immunity, yet its prognostic value in sepsis remains uncertain due to inconsistent evidence. This meta-analysis seeks to clarify the relationship between the CALLY index and prognosis in septic patients.MethodsA systematic search of PubMed, Embase, OVID, Web of Science, the China National Knowledge Infrastructure, the Wanfang Database, Google Scholar, and Baidu Scholar was conducted up to November 15, 2025. Studies reporting on the CALLY index’s association with mortality or its levels in sepsis survivors versus non-survivors were included. Data were pooled using standardized mean differences (SMDs), hazard ratios (HRs), and odds ratios (ORs) with 95% confidence intervals (CIs) under a random-effects model.ResultsThis meta-analysis incorporated a total of six studies, encompassing seven cohorts and comprising 3,848 patients with sepsis. Overall, the CALLY index did not significantly differ between survivors and non-survivors (pooled SMD = −0.22, 95% CI: −1.18 to 0.74). However, subgroup analyses revealed a marked divergence: a higher CALLY index was correlated with survival in Chinese cohorts (SMD = −1.04, 95% CI: −1.69 to −0.39), whereas it was associated with mortality in the Turkish cohort (SMD = 1.39, 95% CI: 1.02 to 1.75). Multivariate analysis further showed a significant association between a higher CALLY index and a lower mortality risk (HR = 0.48, 95% CI: 0.33–0.69). The diagnostic accuracy of the CALLY index for predicting mortality was moderate, with a pooled sensitivity of 0.59 and specificity of 0.77. Significant heterogeneity was observed across all pooled analyses.ConclusionThe CALLY index shows promise as a low-cost sepsis biomarker, but its variable link to mortality across ethnic groups requires validation in large, multinational prospective studies.Systematic review registrationIdentifier: INPLASY2025120023. http://inplasy.com
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