Association between C-reactive protein-albumin-lymphocyte (CALLY) index and atrial fibrillation recurrence: A...

The C-reactive protein-albumin-lymphocyte (CALLY) index reflects the body's inflammatory, nutritional, and immune status, and has been shown to correlate with cancer prognosis. However, its impact on atrial fibrillation (AF) ablation outcomes remains unclear. We retrospectively analyzed 1042 AF patients who underwent catheter-based radiofrequency catheter ablation (RFCA) at 2 tertiary hospitals in China: The Fourth Affiliated Hospital of Zhejiang University School of Medicine and Taizhou Hospital of Zhejiang Province. Each patient was followed for at least 3 months. AF recurrence was defined as the occurrence of atrial arrhythmias (atrial tachycardia, atrial flutter, or atrial fibrillation) lasting longer than 30 seconds after RFCA. Cox regression was used to explore the association between the CALLY index and AF recurrence, while restricted cubic spline (RCS) plots were employed to elucidate the relationship. Receiver operating characteristic curves were generated to compare the predictive value of the CALLY index with traditional immune-inflammatory markers: the Systemic Immune-Inflammation Index, platelet/high-density lipoprotein ratio, and neutrophil/high-density lipoprotein ratio. Among the 1042 patients who underwent AF RFCA, the median age was 57 years (interquartile range [IQR], 57-70 years). A total of 211 patients (20.25%) experienced AF recurrence, with a median follow-up duration of 27.00 months (IQR, 17.00-42.00 months). The median CALLY index was 5.22 (IQR, 2.11-10.72). After adjusting for confounding factors, the CALLY index was found to be a protective factor for AF recurrence. For each 1-unit increase in the CALLY index, the hazard of AF recurrence decreased by 10% (adjusted hazard ratio = 0.8974, 95% confidence interval [CI]: 0.8674-0.9284, P < .001). RCS plots revealed a nonlinear association between the CALLY index and AF recurrence (P overall < .001). The CALLY index demonstrated superior predictive value compared to traditional immune-inflammatory markers (AUC = 0.667, 95% CI: 0.628-0.706). The CALLY index before AF ablation is associated with AF recurrence outcomes. It provides a comprehensive reflection of the pre-ablation inflammatory, nutritional, and immune status in AF patients and demonstrates better predictive value compared to traditional immune-inflammatory markers.