Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 3;10(17):e37197.
doi: 10.1016/j.heliyon.2024.e37197. eCollection 2024 Sep 15.

Associations of C-reactive protein-albumin-lymphocyte (CALLY) index with cardiorenal syndrome: Insights from a population-based study

Zhehao Xu  1 , Jiao Tang  2 , Xin Chen  2 , Yian Jin  1 , Huanji Zhang  2 , Ruiyun Liang  3
Affiliations

Associations of C-reactive protein-albumin-lymphocyte (CALLY) index with cardiorenal syndrome: Insights from a population-based study

Zhehao Xu et al. Heliyon. .

Abstract

Background: Cardiorenal syndrome (CRS) is a complex condition characterized by the interplay of immune imbalance and inflammation. The C-reactive protein-Albumin-lymphocyte (CALLY) CALLY index serves as a new immune-nutritional scoring system, but its predictive value for CRS remains to be established.

Methods: In this study, we analyzed data from 27,978 participants in National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The CALLY index was calculated as the ratio of albumin to lymphocyte, divided by C-reactive protein (CRP) multiplied by 104. CRS was defined by the coexistence of cardiovascular disease and chronic kidney disease (eGFR <60 mL/min/1.73 m2). Multivariate weighted logistic regression models were employed to determine the odds ratio and 95 % confidence interval for the association between the CALLY index and CRS. Receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) curves were used to assess the predictive efficacy and nonlinear relationship, respectively.

Results: The prevalence of CRS in the study population was 1.22 %. Our findings revealed a significant inverse relationship between the CALLY index and CRS risk, with lower CALLY index values being associated with a higher likelihood of CRS (OR = 0.95, 95 % CI = 0.94-0.96, P < 0.001). Participants in higher quartiles of the CALLY index showed a progressively reduced risk of CRS (P for trend <0.001). Moreover, the CALLY index demonstrated superior predictive performance compared to other inflammatory indicators, such as systemic immune-inflammation index (SII), neutrophil/high-density lipoprotein ratio (NHR), lymphocyte/high-density lipoprotein ratio (LHR), monocyte/high-density lipoprotein ratio (MHR), and platelet/high-density lipoprotein ratio (PHR) (AUC = 0.672, 95 % CI = 0.643-0.701).

Conclusions: This study underscores the significant negative correlation between the CALLY index and the risk of cardiorenal syndrome. The CALLY index emerges as a robust and independent predictor of CRS, outperforming traditional inflammatory markers. This finding highlights the potential utility of the CALLY index as a clinical tool for identifying individuals at risk for CRS.

Keywords: Albumin; C-reactive protein; Cardiorenal syndrome; Inflammation; Lymphocyte; NHANES.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Inclusion and exclusion process of the study participants. Abbreviations: NHANES, National Health and Nutrition Examination Survey; eGFR, estimated glomerular filtration rate; CALLY, C-reactive protein-albumin-lymphocyte.
Fig. 2
Fig. 2
Nonlinear associations of CALLY index with CRS. A. Unadjusted. B Adjusted for age, gender, education levels, race and BMI C. Generalized additive model curve; CALLY: C-reactive protein-albumin-lymphocyte; CRS cardiorenal syndrome.
Fig. 3
Fig. 3
ROC curves and the AUC values of the six inflammatory biomarkers (CALLY, SII, NHR, PHR, MHR, and LHR) in diagnosing CRS. CALLY: C-reactive protein-albumin-lymphocyte; SII: systemic immune-inflammation index; NHR, neutrophil/high-density lipoprotein ratio; MHR, monocyte-high-density lipoprotein ratio; LHR, lymphocyte high-density lipoprotein ratio, PHR, platelet high-density lipoprotein ratio. ROC Curve, receiver operating characteristic curve.
See this image and copyright information in PMC

References

    1. Rangaswami J., et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2019;139(16):e840–e878. - PubMed
    1. Mentz R.J., Lewis E.F. Epidemiology of cardiorenal syndrome. Cardiol. Clin. 2011;29(2):301–314. - PubMed
    1. Karabağ Y., et al. The C-reactive protein to albumin ratio predicts acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Heart Lung Circ. 2019;28(11):1638–1645. - PubMed
    1. Clementi A., et al. Neurohormonal, endocrine, and immune dysregulation and inflammation in cardiorenal syndrome. Cardiorenal Med. 2019;9(5):265–273. - PubMed
    1. Rencuzogullari I., et al. Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. Rev. Port. Cardiol. 2019;38(4):269–277. - PubMed

LinkOut - more resources