Baseline CALLY index is associated with all-cause mortality in HBV-ACLF patients receiving ALSS therapy

Chronic hepatitis B virus (HBV)-associated acute-on-chronic liver failure (HBV-ACLF) has a high mortality rate even with the use of artificial liver support systems (ALSS). Reliable prognostic biomarkers are lacking. This study investigates the association between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, measured at diagnosis, and all-cause mortality in HBV-ACLF patients receiving ALSS treatment.

This single-center retrospective cohort study enrolled consecutive adult patients with HBV-ACLF who received ALSS therapy at the General Hospital of Ningxia Medical University between May 2022 and November 2025. Baseline CALLY was calculated before ALSS initiation. Restricted cubic spline analysis, Kaplan-Meier survival analysis, and Cox regression were used to evaluate the association between CALLY and all-cause mortality. Logistic regression was used to assess its associations with major complications. Time-dependent ROC curves, Brier scores, calibration curves, and decision curve analysis were applied to evaluate the predictive performance and clinical utility of CALLY alone and in combination with conventional prognostic scores.

A total of 221 patients with HBV-ACLF were included, among whom 99 experienced all-cause mortality during follow-up. Patients with low CALLY had more severe systemic inflammation, poorer nutritional and immune status, higher proportions of hepatic encephalopathy and renal insufficiency, and more advanced disease severity than those with high CALLY. Restricted cubic spline analysis showed a significant nonlinear inverse association between baseline CALLY and all-cause mortality risk. Kaplan-Meier analysis demonstrated significantly better overall survival in the high-CALLY group than in the low-CALLY group (log-rank P < 0.0001). In Cox regression analysis, higher CALLY was consistently associated with a lower risk of all-cause mortality. Time-dependent ROC analysis showed that CALLY had good discriminative ability for predicting all-cause mortality at 3, 6, and 12 months, with AUCs of 0.822, 0.837, and 0.888, respectively. The addition of CALLY to AARC grade, Child-Pugh score, MELD score, and MELD-Na score significantly improved the AUCs of the corresponding models. Brier score, calibration curve, and decision curve analyses further supported the incremental predictive value and clinical utility of CALLY?

The baseline CALLY index was inversely associated with all-cause mortality in HBV-ACLF patients receiving ALSS therapy and may enhance prognostic assessment, especially when integrated with conventional prognostic scoring systems.