The CALLY index, a novel composite biomarker, is inversely associated with preserved ratio impaired spirometry (PRISm): A nationally representative cross-sectional study
- 1Health Management Center, Gansu Province Central Hospital, Lanzhou, P.R. China.
Abstract
Preserved ratio impaired spirometry (PRISm) is an intermediate pulmonary phenotype with heightened cardiometabolic risk. Effective tools for its identification are lacking. However, its relationship with systemic inflammatory-nutritional balance is underexplored. The CALLY index integrates C-reactive protein, albumin, and lymphocyte count. This composite biomarker reflects inflammatory-nutritional homeostasis. This study aimed to investigate the association between the ln(CALLY) index and PRISm in a nationally representative U.S. adult population. We analyzed data from 7296 participants in the National Health and Nutrition Examination Survey (NHANES) 2007–2010. PRISm was defined as FEV1/FVC ≥ 0.7 with FEV1 < 80% predicted. Multivariable logistic regression models assessed the association between ln(CALLY) (as quartiles and per-standard-deviation increases) and PRISm, with sequential adjustment for demographic, socioeconomic, and cardiometabolic factors. Restricted cubic splines examined the dose-response relationship. Subgroup and sensitivity analyses evaluated the robustness of findings. Among participants, 920 (12.6%) had PRISm. Compared to those with normal pulmonary function, PRISm individuals had significantly lower ln(CALLY) values (1.21 vs 1.77, P < .001). In fully adjusted models, higher ln(CALLY) quartiles had progressively lower PRISm odds: Q2 (OR = 0.71, 95% CI:0.57–0.88), Q3 (OR = 0.63, 0.47–0.84), and Q4 (OR = 0.48, 0.35–0.66) vs Q1 (P-trend < 0.001). Each standard deviation increase in ln(CALLY) reduced PRISm risk by 24% (OR = 0.76, 0.68–0.85). Restricted cubic spline analysis showed a monotonic inverse linear dose-response relationship (P-overall < .001, P-nonlinear = .707). Subgroup analyses found stronger protective associations in women (P-interaction = .021) and significant heterogeneity across racial/ethnic groups (P-interaction = .036). Sensitivity analyses treating BMI continuously and using multiple imputation supported these findings. Higher ln(CALLY) is independently associated with lower PRISm prevalence in U.S. adults. Systemic inflammatory-nutritional status may be a modifiable risk factor for PRISm, supporting potential targeted prevention strategies. The CALLY index, derived from routine blood tests, could serve as a readily accessible tool for risk stratification of PRISm.
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BibTeX
@article{ye2026cally,
title = {{The CALLY index, a novel composite biomarker, is inversely associated with preserved ratio impaired spirometry (PRISm): A nationally representative cross-sectional study}},
author = {Yucai Ye and Youhong Zhao and Liya Jin and Juanxue Zhang and Qiong Jia and Wenjuan Bai and Yanjiong Wang},
journal = {Medicine},
year = {2026},
month = nov,
doi = {10.1097/md.0000000000051472},
url = {https://doi.org/10.1097/md.0000000000051472},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The CALLY index, a novel composite biomarker, is inversely associated with preserved ratio impaired spirometry (PRISm): A nationally representative cross-sectional study
AU - Yucai Ye
AU - Youhong Zhao
AU - Liya Jin
AU - Juanxue Zhang
AU - Qiong Jia
AU - Wenjuan Bai
AU - Yanjiong Wang
PY - 2026
DA - 2026/11/06
JO - Medicine
DO - 10.1097/md.0000000000051472
UR - https://doi.org/10.1097/md.0000000000051472
AB - Preserved ratio impaired spirometry (PRISm) is an intermediate pulmonary phenotype with heightened cardiometabolic risk. Effective tools for its identification are lacking. However, its relationship with systemic inflammatory-nutritional balance is underexplored. The CALLY index integrates C-reactive protein, albumin, and lymphocyte count. This composite biomarker reflects inflammatory-nutritional homeostasis. This study aimed to investigate the association between the ln(CALLY) index and PRISm in a nationally representative U.S. adult population. We analyzed data from 7296 participants in the National Health and Nutrition Examination Survey (NHANES) 2007–2010. PRISm was defined as FEV1/FVC ≥ 0.7 with FEV1 < 80% predicted. Multivariable logistic regression models assessed the association between ln(CALLY) (as quartiles and per-standard-deviation increases) and PRISm, with sequential adjustment for demographic, socioeconomic, and cardiometabolic factors. Restricted cubic splines examined the dose-response relationship. Subgroup and sensitivity analyses evaluated the robustness of findings. Among participants, 920 (12.6%) had PRISm. Compared to those with normal pulmonary function, PRISm individuals had significantly lower ln(CALLY) values (1.21 vs 1.77, P < .001). In fully adjusted models, higher ln(CALLY) quartiles had progressively lower PRISm odds: Q2 (OR = 0.71, 95% CI:0.57–0.88), Q3 (OR = 0.63, 0.47–0.84), and Q4 (OR = 0.48, 0.35–0.66) vs Q1 (P-trend < 0.001). Each standard deviation increase in ln(CALLY) reduced PRISm risk by 24% (OR = 0.76, 0.68–0.85). Restricted cubic spline analysis showed a monotonic inverse linear dose-response relationship (P-overall < .001, P-nonlinear = .707). Subgroup analyses found stronger protective associations in women (P-interaction = .021) and significant heterogeneity across racial/ethnic groups (P-interaction = .036). Sensitivity analyses treating BMI continuously and using multiple imputation supported these findings. Higher ln(CALLY) is independently associated with lower PRISm prevalence in U.S. adults. Systemic inflammatory-nutritional status may be a modifiable risk factor for PRISm, supporting potential targeted prevention strategies. The CALLY index, derived from routine blood tests, could serve as a readily accessible tool for risk stratification of PRISm.
SN - 0025-7974
SN - 1536-5964
ER -