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Published on: January 28, 2020
The C Reactive Protein Albumin Lymphocyte Index Refines Prognostic Prediction after Endovascular Repair of Type B
Xingfeng Chen1, Linfeng Xie2, Yuling Xie2
1Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, China; NHC Key Laboratory of Etiological Epidemiology of Chronic Diseases with High Incidence in Fujian-Taiwan Area, Fujian Medical University, Fuzhou, Fujian, China.
Objective:
Systemic inflammation is central to aortic wall degradation in type B aortic dissection (TBAD). This multicentre, retrospective cohort study aimed to evaluate the prognostic value of the C reactive protein albumin lymphocyte (CALLY) index-which integrates inflammation, nutrition, and immunity-for predicting aorta related adverse events (ARAEs) after thoracic endovascular aortic repair (TEVAR).
Methods:
The study enrolled 547 TBAD patients undergoing TEVAR from three tertiary hospitals. Predictive performance of the CALLY index for short (30 days) and long term (120 months) ARAEs was assessed against established indices using receiver operating characteristic curves (AUC) with Delong's test. Incremental value over a clinical baseline model (age, sex, hypertension) was quantified via net reclassification improvement and integrated discrimination improvement. Clinical utility was evaluated by decision curve analysis (DCA). Multivariate Cox regression identified independent predictors of ARAEs.
Results:
The CALLY index demonstrated superior discriminative ability for both short term (AUC 0.757, 95% confidence interval [CI] 0.69 - 0.84) and long term (AUC 0.775, 95% CI 0.73 - 0.82) ARAEs, significantly outperforming all other indices (all p < .001). It improved risk reclassification over the baseline model (long term net reclassification improvement 0.402, 95% CI 0.28 - 0.52; p < .001), and DCA confirmed clinical net benefit. A low pre-operative CALLY index was the strongest independent predictor of short term (adjusted hazard ratio [aHR] 5.390, 95% CI 2.34 - 12.41; p < .001) and long term (aHR 4.102, 95% CI 2.85 - 5.90; p < .001) ARAEs. Post-operatively, the CALLY index increased significantly (p = .027), with greater increases in patients without subsequent ARAEs (p < .001). A low CALLY index was associated with lower rates of complete false lumen thrombosis (60.6% vs. 73.8%; p < .001).
Conclusion:
The pre-operative CALLY index is a valuable, integrative biomarker that refines risk stratification and predicts impaired aortic remodelling post-TEVAR. It may inform personalised post-operative management strategies in TBAD patients.
