Preoperative C-Reactive Protein-Albumin-Lymphocyte (CALLY) Score and the Risk of Acute Kidney Injury Following...

The C-reactive protein-albumin-lymphocyte (CALLY) score integrates inflammation, nutrition, and immune status. Its association with acute kidney injury (AKI) following cardiac surgery remains unclear.

This retrospective cohort study included 1,302 patients (mean age 60.4 ± 10.7 years; 56.4% male) who underwent major cardiac surgery at a tertiary hospital between October 2017 and October 2023. Multivariable Poisson regression with robust standard errors was used to estimate the association between preoperative CALLY score and postoperative AKI. Restricted cubic spline analysis with three knots was employed to assess potential nonlinearity in the dose-response relationship.

Postoperative AKI occurred in 487 (37.4%;95% CI: 34.8%-40.1%) patients. Patients were categorized into quartiles: Q1 (0.1 ≤ CALLY ≤ 1.1), Q2 (1.1 < CALLY ≤ 3.7), Q3 (3.7 < CALLY ≤ 7.5), and Q4 (7.5 < CALLY ≤ 35). Compared with the Q4, the adjusted incidence rate ratios for AKI were 1.45 (95% CI: 1.17-1.80) for Q1, 1.31 (95% CI: 1.05-1.63) for Q2, and 1.38 (95% CI: 1.11-1.72) for Q3. A nonlinear association was observed (P for nonlinearity = 0.004), with AKI risk decreasing steeply at lower CALLY values and stabilizing beyond the reference value of 7.5.

Preoperative CALLY score was independently associated with postoperative AKI in a nonlinear, dose‑dependent manner. Although this association suggests the score may be useful for preoperative risk stratification, further prospective studies are needed to determine whether it has clinical utility in guiding preventive interventions.