Negative association of C-reactive protein-albumin-lymphocyte index (CALLY index) with all-cause and cause-specific mortality in patients with cancer

Sep 21, 2026

The study evaluates whether the C-reactive protein–albumin–lymphocyte index (CALLY index), reflecting immune, nutritional, and inflammatory status, correlates with cancer prognosis across multiple cancer types. Using 3,511 U.S. adults with cancer from NHANES 1999–2018, the CALLY index was measured at baseline and linked to mortality outcomes. Cox proportional hazards models tested associations with all-cause and cause-specific death, supported by restricted cubic splines, piecewise regression, and subgroup/sensitivity analyses.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Cancer burden and need for prognostic markers

CALLY index and rationale

Inflammation, malnutrition, and immune status

Zhu et al. BMC Cancer (2024) 24:1499 BMC Cancer [https://doi.org/10.1186/s12885-024-13261-y](https://doi.org/10.1186/s12885-024-13261-y) RESEARCH Open Access Negative association of C-reactive protein- albumin-lymphocyte index (CALLY index) with all-cause and cause-specific mortality in patients with cancer: results from NHANES 1999–2018 Di Zhu 1, Ye-Ding Lin 1, Yan-Zhu Yao 1, Xiang-Jun Qi 1, Kai Qian3 and Li-Zhu Lin2* Abstract Background The CALLY index, which is derived from C-reactive protein (CRP) content, serum albumin level, and total lymphocyte count, reflects the immune, nutritional, and inflammatory status of the body. Lack of sufficient evidence on the correlation between the CALLY index and the prognosis of cancer patients with various cancer forms. This study seeks to elucidate the association between the CALLY index and mortality from all causes as well as specific causes in cancer patients within a U. S. population. Methods This investigation encompassed 3511 cancer-afflicted adults from the National Health and Nutritional Examination Surveys (NHANES) spanning 1999 to 2018. The CALLY index was measured at baseline only. The relationship between the CALLY index and mortality from both all causes and cancer specifically was examined using Cox proportional hazards models. Additionally, restricted cubic spline, piecewise linear regression, and various subgroup and sensitivity analyses were employed. Results Over a median follow-up of 103 months, 1,355 deaths occurred, and the incidence of all-cause mortality for these participants was 38. 34% . Our findings indicate that an elevated CALLY index correlates with a diminished risk of all-cause mortality. Upon applying a natural logarithmic transformation to the CALLY index, the comprehensively adjusted model revealed that each one-unit increment in ln CALLY corresponded to a 18% decrease in all-cause mortality risk among cancer patients (HR = 0 . 82, 95% CI:0 .79–0. 86) . Analyses of mortality due to cardiac and cancerrelated causes yielded consistent results, which were robust across various subgroup and sensitivity analyses. Conclusion The CALLY index demonstrated a linear and negative association with all-cause mortality, as well as mortality caused by cancer and cardiac conditions, highlighting its significant prognostic value in patients with oncological conditions. Keywords CALLY index, Cancer, Population-based study, NHANES, Retrospective study *Correspondence: Li-Zhu Lin [gzucmlinlz@163.com](gzucmlinlz@163.com) 1Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China 2The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China 3Shenzhen Bao’an Chinese Medicine Hospital, Shenzhen, Guangdong, China © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Zhu et al. BMC Cancer (2024) 24:1499 Introduction Cancer, recognized globally as a leading cause of premature de

FAQs

What is the CALLY index and what does it represent?

The CALLY index is derived from C-reactive protein content, serum albumin level, and total lymphocyte count. It reflects immune, nutritional, and inflammatory status.

How was the study conducted to assess mortality risk?

The analysis used 3,511 adults with cancer from NHANES 1999–2018, measuring the CALLY index at baseline only. Associations with all-cause and cause-specific mortality were evaluated using Cox proportional hazards models with additional regression and subgroup/sensitivity analyses.

What did the results show about the relationship between CALLY index and mortality?

Higher CALLY index values were associated with lower risk of all-cause mortality. After ln transformation, each one-unit increase in ln CALLY corresponded to an 18% decrease in all-cause mortality risk, with consistent findings for cardiac- and cancer-related causes.

Sep 21, 2026

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