Prognostic value of C-reactive protein-albumin-lymphocyte (CALLY) score and CRP-albumin ratio on mortality in patients diagnosed with pulmonary thromboembolism

Abstract

Background Acute pulmonary embolism (PE) requires rapid risk stratification to predict early mortality. We aimed to evaluate the prognostic value of the C-reactive protein-albumin-lymphocyte (CALLY) index and C-reactive protein-to-albumin ratio (CAR) in predicting in-hospital mortality among patients with PE. Methods This retrospective, single-center Study Included 399 Patients Diagnosed with Acute PE Between 2021 and 2025. the Clinical Characteristics and Baseline Laboratory Parameters Were Analyzed. Receiver Operating Characteristic (ROC) Curves Were Used to Determine the Optimal Biomarker cut-offs. Univariate and Multivariate Logistic Regression Models Were Constructed to Evaluate the Independent Predictors of Mortality Results Non-survivors (n=88,22.0%) had significantly lower CALLY indices (0.71 vs. 1.56,p<0.001) and higher CAR values (2.37 vs. 0.93,p<0.001) than survivors (n=311,78.0%). The AUC was 0.655 for CALLY (<1.17 cut-off; 69.1% sensitivity, 57.7% specificity, 86.4% NPV) and 0.643 for CAR (>3.28 cut-off; 42.0% sensitivity, 83.2% specificity, 83.2% NPV) (DeLong test, p=0.582). In multivariate models adjusted for age, sex, and serum creatinine, both a low CALLY index (<1.17; aOR=2.54,95%CI:1.46−4.50,p=0.001) and a high CAR (>3.28; aOR=3.02,95%CI:1.66−5.50,p<0.001) served as independent predictors of in-hospital mortality. Conclusion The baseline CALLY index is a simple, cost-effective, and readily Accessible Biomarker That Independently Predicts in-hospital mortality in Patients with Acute PE. A CALLY Index <1.17 Provides Moderate Sensitivity for Early Emergency Department Risk Stratification, though its overall discriminative performance is modest