Association of the CALLY Index With 30-Day Outcomes After Transcatheter Aortic Valve Replacement

Systemic inflammation and nutritional status influence outcomes after transcatheter aortic valve replacement (TAVR). The C-reactive protein-albumin-lymphocyte (CALLY) index integrates these domains, but its short-term prognostic value and potential nonlinear associations after TAVR remain uncertain.

To evaluate the association of baseline CALLY with 30-day all-cause mortality, acute kidney injury (AKI), and stroke after TAVR, and to explore potential nonlinear relationships.

We retrospectively analyzed 816 consecutive TAVR patients stratified into low (n = 272), middle (n = 273), and high (n = 271) CALLY tertiles. Outcomes were defined according to Valve Academic Research Consortium-3 criteria. Cox models estimated crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable models were adjusted for age, sex, diabetes, and baseline creatinine. Exploratory piecewise Cox models assessed nonlinearity.

Within 30 days, 28 patients died (3.4%), 81 developed AKI (9.9%), and 35 experienced stroke (4.3%). Compared with the low tertile, the middle and high tertiles were associated with lower adjusted risks of AKI (middle: HR 0.53, 95% CI 0.31-0.90; p = 0.018; high: HR 0.50, 95% CI 0.29-0.85; p = 0.011). A similar inverse trend was observed for mortality (high vs. low: HR 0.43, 95% CI 0.18-1.06; p = 0.066), although statistical significance was not reached. No significant association was observed for stroke. Piecewise modeling demonstrated a significant overall association between CALLY and AKI (p = 0.043), suggesting a nonlinear threshold-type relationship with higher risk concentrated at lower CALLY values.

Higher CALLY values were associated with a lower risk of 30-day AKI after TAVR, with evidence of a nonlinear threshold-type relationship. CALLY may serve as a simple inflammatory-nutritional marker for identifying patients at increased risk of early renal complications.