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Predictive Value of the CALLY Index for Interventional Management in Vaginal Cuff Hematoma Following Hysterectomy
Candost Hanedan1, Ayşe Nur İnal2, Ayşe Yiğit2
1Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey.
Insights
The CALLY index, a novel biomarker, effectively identifies patients needing intervention for vaginal cuff hematoma after hysterectomy. This simple test aids in early risk stratification for better patient outcomes.
Area of Science:
- Gynecology
- Surgical Complications
- Biomarkers
Background:
- Vaginal cuff hematoma is a known complication post-hysterectomy, sometimes necessitating invasive treatment.
- Currently, no bedside biomarker reliably predicts which patients will require intervention over conservative management.
- This study investigates predictive markers for symptomatic vaginal cuff hematoma requiring intervention.
Purpose of the Study:
- To determine the incidence and characteristics of symptomatic vaginal cuff hematoma across hysterectomy types.
- To evaluate the predictive performance of the CALLY index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for identifying patients needing interventional management.
- To assess the CALLY index's utility in risk stratification for symptomatic vaginal cuff hematoma.
Main Methods:
- Retrospective cohort study of 61 patients with symptomatic vaginal cuff hematoma post-hysterectomy.
- Patients were categorized into conservative (n=38) and interventional (n=23) management groups.
- The CALLY index, NLR, PLR, and SII were calculated and compared using receiver operating characteristic (ROC) curve analysis.
Main Results:
- The overall incidence of symptomatic vaginal cuff hematoma was 1.9%, with variations by hysterectomy approach.
- The interventional group showed significantly higher CRP, NLR, and SII, and a lower CALLY index compared to the conservative group.
- The CALLY index demonstrated the highest predictive performance (AUC=0.863), outperforming SII, NLR, and PLR in identifying patients requiring intervention.
Conclusions:
- The CALLY index is a valuable, easily accessible composite biomarker for predicting the need for interventional management in symptomatic vaginal cuff hematoma.
- Its integration into postoperative assessments can enhance risk stratification and facilitate timely clinical decisions.
- The CALLY index shows promise in improving the management of this surgical complication.
Abstract:
Background/Objectives: Vaginal cuff hematoma is a recognized complication following hysterectomy, with a subset of patients requiring invasive intervention. No reliable bedside biomarker currently exists to identify at admission patients likely to fail conservative management. This study aimed to evaluate the incidence and clinical characteristics of symptomatic vaginal cuff hematoma across all hysterectomy approaches, and to assess the predictive performance of the CALLY index (CRP-albumin-lymphocyte index), a composite marker of inflammatory burden, immune function, and nutritional status, alongside the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for identifying patients requiring interventional management. Methods: This retrospective cohort study included 61 patients with symptomatic vaginal cuff hematoma following hysterectomy in a major tertiary referral center (November 2022-July 2025). Patients were divided into conservative (n = 38) and interventional (n = 23) management groups. The CALLY index was calculated as [Albumin (g/dL) × Lymphocyte (×109/L)] ÷ [CRP (mg/L) × 10-2]. Receiver operating characteristic (ROC) curve analysis with the DeLong method was used to compare predictive performance. Results: The overall incidence of symptomatic vaginal cuff hematoma was 1.9% (73/3852 hysterectomies), with the highest rate following vaginal hysterectomy (3.32%) and the lowest after robotic hysterectomy (0.74%). Interventional management was required in 37.7% of patients. The interventional group had significantly higher CRP (192 vs. 62 mg/L, p < 0.001), NLR (7.53 vs. 4.17, p < 0.001), and SII (2308 vs. 1207, p < 0.001), and significantly lower CALLY index values (2.00 vs. 9.80, p < 0.001). The CALLY index demonstrated the highest predictive performance (AUC = 0.863, 95% CI: 0.762-0.964), outperforming SII (AUC = 0.801), NLR (AUC = 0.789), and PLR (AUC = 0.654). At the optimal cutoff of ≤2.89, the CALLY index yielded a sensitivity of 65.2% and a specificity of 92.1%. Conclusions: The CALLY index is a simple, routinely available composite biomarker that may help identify patients at higher risk for interventional management in symptomatic vaginal cuff hematoma. Its incorporation into postoperative assessment may improve risk stratification and support timely clinical decision-making.
