Association of the C-reactive protein-albumin-lymphocyte index with clinical outcomes after mechanical thrombectomy for acute ischemic stroke

Objective This study aims to explore the associations of C-reactive protein-albumin-lymphocyte (CALLY) index with hemorrhagic transformation (HT), malignant cerebral edema (MCE), and 90-day unfavorable outcome and all-cause mortality in patients with acute ischemic stroke (AIS) following mechanical thrombectomy (MT). Methods A retrospective study was conducted. The CALLY index was calculated as albumin × lymphocyte count/(CRP × 10). Unfavorable outcome was defined as the modified Rankin Scale score >2 at 90-day follow-up. Multivariable logistic analyses were performed to evaluate the associations between the CALLY index and clinical outcomes. The restricted cubic spines (RCS) curves were employed for pinpointing any nonlinear associations. In addition, mediation analysis was conducted to assess the potential mediating roles of HT and MCE linking the relationship between the CALLY index and 90-day outcomes. Results A total of 477 patients were enrolled, demonstrating the rates of HT, MCE, unfavorable outcome, and all-cause mortality were 29.8% (142), 22.9 (109), 54.5 (260), and 25.6 (122), respectively. Multivariable logistic analysis revealed that the CALLY index was associated with reduced risk of HT (odds ratio [OR] 0.843, 95% confidence interval [CI] 0.769–0.924, p < 0.001), MCE (OR 0.894, 95% CI 0.824–0.971, p = 0.008), unfavorable outcome (OR 0.895, 95% CI 0.840–0.954, p = 0.001), and mortality (OR 0.907, 95% CI 0.836–0.984, p = 0.019). RCS curves exhibited non-linear relationship between the CALLY index and HT ( p -non-linear = 0.008), manifesting that CALLY index was associated with HT when its value below 2.681 (OR 0.530, 95% CI 0.357–0.785, p = 0.002). Mediation analysis indicated that the association between the CALLY index and unfavorable outcome may be partially mediated by HT (29.1%, p < 0.001) and MCE (28.1%, p = 0.003). Conclusion The CALLY index is associated with reduced risk of HT, MCE, and 90-day unfavorable outcome and all-cause mortality. HT and MCE may be the mediators linking the CALLY index to 90-day unfavorable outcome.