Background/Purpose: This study retrospectively investigated whether the initial C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index at diagnosis can contribute to early prediction of all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods: This study included 323 patients with AAV. Clinical data at AAV diagnosis and those during follow-up were collected. The CALLY index was calculated using the following equation: serum albumin (g/L) × lymphocyte count (/mm3) / CRP (mg/L) /10,000. The parameter of serum albumin (g/L) of an equation of the CALLY index was corrected by multiplying the measured serum albumin (g/dL) by 10.

Results: The median age was 61.0 years (36.2% male and 63.8% female). The median CALLY index was calculated as 0.48. Of the 323 patients, 45 (13.9%) died during the follow-up period of 53.7 months. In ROC curve analysis, the optimal cut-off of the CALLY index for all-cause mortality was determined as 0.55 (area 0.715). Patients with the CALLY index ≤0.55 at AAV diagnosis had a significantly higher risk for death (relative risk 7.294), and exhibited a significantly lower cumulative patients’ survival rate than those with the CALLY index >0.55. In multivariable Cox proportional hazard analysis, the CALLY index ≤0.55 (hazard ratio [HR] 3.913), age (HR 1.037) and male sex (HR 2.326) were independently associated with all-cause mortality during follow-up in patients with AAV.

Conclusion: This is the first study to demonstrate that the initial CALLY index at diagnosis could be useful in predicting all-cause mortality during follow-up in patients with AAV.

*Serum albumin (g/L) = serum albumin (g/dL) × 10

AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody; BMI: body mass index; MPA: microscopic polyangiitis; GPA: granulomatosis with polyangiitis; EGPA: eosinophilic granulomatosis with polyangiitis; MPO: myeloperoxidase; P: perinuclear; PR3: proteinase 3; C: cytoplasmic; BVAS: the Birmingham vasculitis activity score; FFS: the five-factor score; AST: aspartate aminotransferase; ALT: alanine aminotransferase; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; CALLY: C-reactive protein-albumin-lymphocyte.

Fig. 1 Relative risk of the initial CALLY index for all-cause mortality

(A) The cut-off of the CALLY index was determined as 0.55 using ROC curve analysis. (B) Patients with the CALLY index ≤0.55 at AAV diagnosis had a higher risk for death than those without.

CALLY: C-reactive protein-albumin-lymphocyte; ROC: receiver operating characteristic; AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody; RR: relative risk; CI: confidence interval.

Fig. 2 Cumulative survival rates

Patients with the CALLY index ≤0.55 at AAV diagnosis exhibited a significantly lower cumulative patients’ survival rate than those without.

CALLY: C-reactive protein-albumin-lymphocyte; AAV: ANCA-associated vasculitis; ANCA: antineutrophil cytoplasmic antibody.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/contribution-of-the-cally-index-at-diagnosis-to-early-prediction-of-all-cause-mortality-in-patients-with-anca-associated-vasculitis/