# Prognostic Impact of C-reactive Protein-Albumin-Lymphocyte Index in Patients Who Underwent Splenectomy and Devascularization for Gastric Varices Caused by Portal Hypertension

## TL;DR

This study shows that a new blood-based score, the CALLY index, can predict survival outcomes in patients undergoing surgery for gastric varices caused by portal hypertension.

## Contribution

The study introduces the CALLY index as a novel prognostic tool for surgical patients with gastric varices.

## Key findings

- A low CALLY index was significantly associated with worse overall survival in patients undergoing surgery for gastric varices.
- Multivariate analysis confirmed the CALLY index as an independent risk factor for poor survival outcomes.
- Low CALLY patients had higher portal vein pressure after surgery compared to high CALLY patients.

## Abstract

Purpose: The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel nutritional and inflammation-based index. This study aimed to evaluate the prognostic value of the preoperative CALLY index in patients who underwent splenectomy and devascularization (Sp + Dev) for gastric varices caused by portal hypertension.

Methods: This study included 64 patients who underwent Sp + Dev for gastric varices between January 2009 and March 2022. The CALLY index was calculated as (albumin × lymphocyte)/(C-reactive protein × 104), and the patients were divided into high and low CALLY groups. Log-rank tests were performed to compare the overall survival (OS). Independent risk factors for OS were identified by multivariate analysis. Propensity score-matching was performed for survival analysis to balance the selection bias for stratification of the CALLY index.

Results: The cut-off value of the CALLY index was set at 4.35 using receiver-operating characteristic curve analysis, and 39 patients were classified into the low CALLY group. The low CALLY group had significantly worse OS (p = 0.013) than the high CALLY group. Multivariate analysis identified a low CALLY index (hazard ratio (HR) = 3.787; 95% confidence interval (CI) = 1.174-12.218; p = 0.026) and concurrent hepatocellular carcinoma (HR = 2.914; 95% CI = 1.018-8.342; p = 0.046) as independent risk factors for poor OS. After propensity score-matching to balance the selection bias, a low CALLY index significantly correlated with worse OS (p = 0.026). The low CALLY group had significantly worse portal vein pressure after splenectomy than the high CALLY group (p = 0.031).

Conclusions: Preoperative CALLY index is a significant prognostic indicator for gastric varices after Sp + Dev. The CALLY index may be useful in determining the suitability of surgical treatment and perioperative management.