Evaluation of the Relationship Between the CALLY Index and Ranson Criteria and 28-Day Early Mortality in Acute Pancreatitis Patients Admitted to the Emergency Department: A Retrospective Cohort Study
- 1Department of Emergency Medicine, Prof. Dr. Cemil Taşçıoğlu City Hospital, 34384 Istanbul, Turkey
Abstract
Background/Objectives: Acute pancreatitis (AP) is a common gastrointestinal emergency with a highly variable clinical course and substantial mortality. Early risk stratification is critical for guiding treatment and improving outcomes. The C-reactive protein–albumin–lymphocyte (CALLY) index is a novel composite biomarker integrating inflammation, nutritional status, and immune response. This study aimed to evaluate the relationship between the CALLY index and Ranson criteria and to assess the value of the CALLY index in predicting 28-day early mortality in AP patients admitted to the emergency department. Methods: This retrospective cohort study included 200 patients diagnosed with AP who presented to the Emergency Medicine Clinic of Prof. Dr. Cemil Tasoglu City Hospital between 1 January 2024 and 31 December 2025. Demographic characteristics, laboratory parameters, and clinical outcomes were analyzed. The CALLY index was calculated as: CALLY = (Albumin [g/L] × Lymphocyte count [×109/L])/(CRP [mg/L] × 10). Ranson criteria were assessed at admission and 48 h. Spearman correlation analysis was used to evaluate the relationship between the CALLY index and Ranson score. ROC curve analysis with internal validation was performed to assess the predictive performance of the CALLY index for 28-day mortality. Results: The mean age was 57.3 ± 18.4 years; 54.5% were male. The median CALLY index at admission was 1.42 (IQR: 0.48–3.56). Patients with a Ranson score ≥ 3 had significantly lower CALLY index values (median: 0.89 [IQR: 0.42–1.78] vs. 2.45 [IQR: 1.02–4.89], p < 0.001). A significant negative correlation was found between the CALLY index and Ranson score (r = −0.412, p < 0.001). The AUC of the CALLY index for predicting 28-day mortality was 0.782 (95% CI: 0.718–0.846, p < 0.001), with an optimal cut-off of ≤0.85 (sensitivity 81.8% [95% CI: 64.5–99.1], specificity 72.3% [95% CI: 65.8–78.8]). Bootstrap internal validation yielded a corrected AUC of 0.774 (95% CI: 0.702–0.839). The 28-day mortality rate was 18.2% in patients with a CALLY index ≤ 0.85 versus 2.1% in those with a CALLY index > 0.85 (p < 0.001). In multivariable analysis, a CALLY index ≤ 0.85 was independently associated with 28-day mortality (adjusted OR: 7.42, 95% CI: 1.56–35.28, p = 0.012). Conclusions: A low CALLY index at admission is significantly associated with severe disease and 28-day mortality in AP patients. The CALLY index may serve as a rapid, low-cost, and easily calculable prognostic marker in the emergency department, complementing traditional Ranson criteria for risk stratification. External validation in larger, multicenter cohorts is warranted.
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BibTeX
@article{ertem2026evaluation,
title = {{Evaluation of the Relationship Between the CALLY Index and Ranson Criteria and 28-Day Early Mortality in Acute Pancreatitis Patients Admitted to the Emergency Department: A Retrospective Cohort Study}},
author = {Ünal Ertem and Ali Sarıdaş},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15228765},
url = {https://www.mdpi.com/2077-0383/15/22/8765},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluation of the Relationship Between the CALLY Index and Ranson Criteria and 28-Day Early Mortality in Acute Pancreatitis Patients Admitted to the Emergency Department: A Retrospective Cohort Study
AU - Ünal Ertem
AU - Ali Sarıdaş
PY - 2026
DA - 2026/11/10
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15228765
UR - https://www.mdpi.com/2077-0383/15/22/8765
AB - Background/Objectives: Acute pancreatitis (AP) is a common gastrointestinal emergency with a highly variable clinical course and substantial mortality. Early risk stratification is critical for guiding treatment and improving outcomes. The C-reactive protein–albumin–lymphocyte (CALLY) index is a novel composite biomarker integrating inflammation, nutritional status, and immune response. This study aimed to evaluate the relationship between the CALLY index and Ranson criteria and to assess the value of the CALLY index in predicting 28-day early mortality in AP patients admitted to the emergency department. Methods: This retrospective cohort study included 200 patients diagnosed with AP who presented to the Emergency Medicine Clinic of Prof. Dr. Cemil Tasoglu City Hospital between 1 January 2024 and 31 December 2025. Demographic characteristics, laboratory parameters, and clinical outcomes were analyzed. The CALLY index was calculated as: CALLY = (Albumin [g/L] × Lymphocyte count [×109/L])/(CRP [mg/L] × 10). Ranson criteria were assessed at admission and 48 h. Spearman correlation analysis was used to evaluate the relationship between the CALLY index and Ranson score. ROC curve analysis with internal validation was performed to assess the predictive performance of the CALLY index for 28-day mortality. Results: The mean age was 57.3 ± 18.4 years; 54.5% were male. The median CALLY index at admission was 1.42 (IQR: 0.48–3.56). Patients with a Ranson score ≥ 3 had significantly lower CALLY index values (median: 0.89 [IQR: 0.42–1.78] vs. 2.45 [IQR: 1.02–4.89], p < 0.001). A significant negative correlation was found between the CALLY index and Ranson score (r = −0.412, p < 0.001). The AUC of the CALLY index for predicting 28-day mortality was 0.782 (95% CI: 0.718–0.846, p < 0.001), with an optimal cut-off of ≤0.85 (sensitivity 81.8% [95% CI: 64.5–99.1], specificity 72.3% [95% CI: 65.8–78.8]). Bootstrap internal validation yielded a corrected AUC of 0.774 (95% CI: 0.702–0.839). The 28-day mortality rate was 18.2% in patients with a CALLY index ≤ 0.85 versus 2.1% in those with a CALLY index > 0.85 (p < 0.001). In multivariable analysis, a CALLY index ≤ 0.85 was independently associated with 28-day mortality (adjusted OR: 7.42, 95% CI: 1.56–35.28, p = 0.012). Conclusions: A low CALLY index at admission is significantly associated with severe disease and 28-day mortality in AP patients. The CALLY index may serve as a rapid, low-cost, and easily calculable prognostic marker in the emergency department, complementing traditional Ranson criteria for risk stratification. External validation in larger, multicenter cohorts is warranted.
SN - 2077-0383
ER -