Ineffective Recanalization and Complications in Patients with Acute Ischemic Stroke Receiving Endovascular Treatment: Predictive Value of the c-Reactive Protein-Albumin-Lymphocyte (CALLY) Index

Lin Zhu,1 Sanming Jie,1 Shuhua Wu,1 Qin Chen,1 Xuhui Zhang,1 Wenwu Yang,2 Yongming Wu1 1Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Neurosurgery, the 981 Hospital of the Chinese People’s Liberation Army, Chengde, People’s Republic of ChinaCorrespondence: Wenwu Yang, Department of Neurosurgery, the 981 Hospital of the Chinese People’s Liberation Army, Puning Road, Shuangqiao District, Chengde, 067000, People’s Republic of China, Email [email protected] Yongming Wu, Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, People’s Republic of China, Tel +86 13711530187, Email [email protected]: The C-reactive protein–albumin–lymphocyte (CALLY) index, as a composite biomarker reflecting nutritional reserves and immunosuppression, has demonstrated important predictive value in various disease. We aimed to investigate the CALLY index’s predictive value versus previous inflammatory-nutritional biomarker for ineffective recanalization and complications in acute ischemic stroke (AIS) patients who received emergency endovascular therapy (EVT).Methods: We retrospectively reviewed 705 AIS patients admitted to Nanfang Hospital for EVT from January 2019 to December 2023. We calculated the CALLY index, Geriatric Nutritional Risk Index, Controlling Nutritional Status score, Prognostic Nutritional Index, and C-reactive protein-to-albumin ratio, and assessed their predictive significance for ineffective recanalization using univariate and multivariate logistic regression. Predictive efficacy was compared via receiver operating characteristic (ROC) curve analysis, while the Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) quantified the incremental value of models incorporating these biomarkers. In addition, we explored the relationship between the CALLY index and post-EVT complications.Results: The CALLY index had the best predictive validity with an area under the ROC curve of 0.73. The new model incorporating the CALLY index had the best optimization effect (NRI of 0.157, P=0.028; IDI of 0.029, P=0.008). A significant correlation was also shown between the CALLY index and stroke-associated pneumonia.Conclusion: The CALLY Index demonstrated its potential as an innovative and accessible indicator for prognosis.Keywords: acute ischemic stroke, prognosis, biomarker, stroke-associated pneumonia, nutrition, inflammation