# C-reactive Protein-Albumin-Lymphocyte (CALLY) Index in Patients With Sepsis: An Observational Study

## TL;DR

A new biomarker called CALLY index was studied in sepsis patients and found to correlate with disease severity, but the results may not apply broadly due to limited data.

## Contribution

The study introduces and evaluates the CALLY index as a novel composite biomarker for sepsis severity.

## Key findings

- The CALLY index showed a negative correlation with the SOFA score in sepsis patients.
- Male and female patients had similar CALLY indices and disease severity scores.
- Most patients had multiorgan dysfunction syndrome, with a median SOFA score of 5.

## Abstract

Background and objectives: Sepsis and multiorgan dysfunction syndrome (MODS) are serious global health concerns. Patients with critical illnesses are assessed using the sequential organ failure assessment (SOFA) score for morbidity. The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a novel composite biomarker for sepsis. It is composed of three parameters: absolute lymphocyte count, CRP, and serum albumin. The purpose of this study was to examine the CALLY index in male and female sepsis patients. Additionally, we correlated the SOFA score and CALLY index of the study participants at admission.

Methods: This observational study was carried out from August 2025 to December 2025 at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. Adult patients of both sexes fulfilling Sepsis-3 criteria were included in this study. We recorded their absolute lymphocyte count, CRP, and serum albumin for the computation of the CALLY index. SOFA scores were noted at days 1, 3, and 7. The categorical and continuous variables were assessed with the Chi-squared and Wilcoxon tests, respectively. We used the Spearman correlation to assess the association between the SOFA score at day 1 and the CALLY index for the subjects. R software (version 4.3.2; R Foundation for Statistical Computing, Vienna, Austria) was used for data analysis.

Results: Two hundred sixty-three patients were analyzed in this study. Their median age was 62.0 (52.0-73.0) years. One hundred sixty-one (61.22%) subjects were males. The median hospitalization duration was 12.0 (9.0-16.0) days. Two hundred fourteen (81.37%) subjects had MODS. The median CRP, serum albumin, and lymphocyte count values of the study population were 112.97 (77.95-206.82) mg/L, 2.78 (2.36-3.17) g/dL, and 1.09 (0.67-1.72) x 109/L. The median CALLY index of the subjects was 2.48 (1.34-4.94). The median SOFA score during admission was 5.0 (3.0-8.0). There was a negative correlation between SOFA score at day 1 and CALLY index (-0.299, 95% confidence interval (CI): -0.406 to -0.185, p < 0.001). Male and female subjects also showed similar negative correlations.

Conclusion: Male and female subjects with sepsis had comparable CRP, serum albumin, lymphocyte count, CALLY indices, and SOFA scores. The CALLY index and SOFA score were negatively correlated. Our study findings cannot be generalized due to a small sample size and missing data on antibiotics used; hemodynamic, renal, hepatic, and glycemic parameters; comorbidities; concomitant medications; daily fluid intake; and urine output.