Association of C-reactive protein-albumin-lymphocyte index with liver cirrhosis severity and factors associated with adverse prognosis of patients with chronic hepatitis B

doi:10.3877/cma.j.issn.1674-1358.2026.04.006

Abstract

Abstract:

Objective

To investigate the correlation between the severity of liver cirrhosis in chronic hepatitis B (CHB) and C-reactive protein-albumin-lymphocyte (CALLY) index, and to identify the influencing factors of adverse prognosis.

Methods

Total of 112 patients with CHB-related cirrhosis admitted in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 1st, 2023 to January 1st, 2024 were enrolled, retrospectively. According to the median CALLY index at admission (1.35), patients were divided into high-CALLY group and low-CALLY group, with 56 cases in each group. Baseline characteristics were compared between the two groups. The correlation between CALLY index and Child-Pugh grades were assessed by Spearman rank correlation analysis. The prognostic performance of CALLY index was evaluated by receiver operating characteristic (ROC) curve analysis. The overall survival between the two groups were compared by Kaplan-Meier analysis and Log-rank test, and the influencing factors of prognosis in patients with CHB-related cirrhosis were identifed by Cox proportional hazards regression.

Results

The levels of C-reactive protein (Z=4.106, P＜0.001), serum free cortisol (t=－2.140, P=0.035), copeptin (t=－3.873, P＜0.001), neutrophil count (t=－3.606, P＜0.001), albumin (t=－7.917, P<0.001), serum total bilirubin (t=4.923, P＜0.001), prolongation of prothrombin time (t=8.120, P<0.001) and Child-Pugh grade (Z=－1.994, P=0.046) were significantly different between patients with CHB-related liver cirrhosis in high-CALLY group and low-CALLY group. The area under the ROC curve (AUC) of the CALLY index for predicting 2-year all-cause mortality was 0.714 (95%CI: 0.581-0.834), with an optimal cutoff value of 1.23, the sensitivity and specificity were 71.4% and 62.6%, respectively. The CALLY index was negatively correlated with Child-Pugh grade (r=－0.610, P＜0.001). The 2-year overall survival rates were 91.1% and 71.4% in high-CALLY and low-CALLY groups, respectively, with significant difference (Log-rank χ²=7.323, P=0.007). Multivariable Cox regression analysis showed that monocyte count (HR=1.18, 95%CI: 1.03-1.36, P=0.018) and Child-Pugh grade (HR=2.17, 95%CI: 1.07-4.40, P=0.032) were both risk factors for poor prognosis of CHB-related liver cirrhosis, whereas the standardized CALLY score was not an independent influencing factor of all-cause mortality (HR=0.69, 95%CI: 0.30-1.60, P=0.386).

Conclusions

The CALLY index exhibits a certain association with the severity of liver cirrhosis and survival outcomes; it can serve as an auxiliary risk stratification parameter complementing conventional clinical indicators, although its independent prognostic value still requires further validation.

Key words: C-reactive protein-albumin-lymphocyte index, Hepatitis B, Cirrhosis, Correlation analysis, Influencing factor

Ying Li, Jing Pan. Association of C-reactive protein-albumin-lymphocyte index with liver cirrhosis severity and factors associated with adverse prognosis of patients with chronic hepatitis B[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2026, 20(04): 239-245.

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Figures/Tables 6

基线资料	低CALLY组（56例）	高CALLY组（56例）	统计量	P值
性别 [例（%）]			χ²=0.571	0.450
男	32（57.14）	28（50.00）
女	24（42.86）	28（50.00）
年龄（ $x ¯$ ±s，岁）	61.2±14.3	62.1±8.2	t=－0.429	0.669
BMI（ $x ¯$ ±s）	27.2±5.2	27.5±5.4	t=－0.302	0.763
C-反应蛋白 [M（P₂₅，P₇₅），mg/L]	13.2（9.5，19.8）	9.0（6.2，13.5）	Z=4.106	＜0.001
白细胞[M（P₂₅，P₇₅），×10³/μl]	7.0（4.8，10.5）	6.3（4.2，9.2）	Z=1.058	0.292
血清游离皮质醇（ $x ¯$ ±s，nmol/L）	450±120	500±130	t=－2.140	0.035
加压素前体肽（ $x ¯$ ±s，pmol/L）	12.5±3.2	15.0±4.0	t=－3.873	＜0.001
中性粒细胞计数（ $x ¯$ ±s，×10⁹/L）	3.2±1.0	4.2±1.8	t=－3.606	＜0.001
单核细胞计数（ $x ¯$ ±s，×10⁹/L）	0.3±0.1	0.3±0.1	t=－1.026	0.307
淋巴细胞 [M（P₂₅，P₇₅），×10⁹/L）]	1.1（0.6，1.8）	0.9（0.5，1.5）	Z=1.647	0.100
白蛋白（ $x ¯$ ±s，g/L）	28.6±5.3	37.5±6.5	t=－7.917	＜0.001
凝血酶原时间活性（ $x ¯$ ±s，%）	69.4±14.2	70.1±13.6	t=－0.277	0.782
天冬氨酸氨基转移酶 [M（P₂₅，P₇₅），IU/L]	33.0（24.0，50.0）	31.0（22.0，47.0）	χ²=0.525	0.600
丙氨酸氨基转移酶（ $x ¯$ ±s，IU/L）	30.1±2.5	29.9±2.6	t=0.424	0.672
血清胆红素（ $x ¯$ ±s，mg/dl）	3.5±1.2	2.5±0.8	t=4.923	＜0.001
凝血酶原时间延长值（ $x ¯$ ±s，s）	5.0±1.5	3.0±1.0	t=8.120	＜0.001
腹水 [例（%）]	30（53.6）	20（35.7）	χ²=3.733	0.053
Child-Pugh分级 [例（%）]			χ²=－1.994	0.043
A级	20（35.7）	30（53.6）
B级	25（44.6）	20（35.7）
C级	11（19.6）	6（10.7）

基线资料	低CALLY组（56例）	高CALLY组（56例）	统计量	P值
性别 [例（%）]			χ²=0.571	0.450
男	32（57.14）	28（50.00）
女	24（42.86）	28（50.00）
年龄（ $x ¯$ ±s，岁）	61.2±14.3	62.1±8.2	t=－0.429	0.669
BMI（ $x ¯$ ±s）	27.2±5.2	27.5±5.4	t=－0.302	0.763
C-反应蛋白 [M（P₂₅，P₇₅），mg/L]	13.2（9.5，19.8）	9.0（6.2，13.5）	Z=4.106	＜0.001
白细胞[M（P₂₅，P₇₅），×10³/μl]	7.0（4.8，10.5）	6.3（4.2，9.2）	Z=1.058	0.292
血清游离皮质醇（ $x ¯$ ±s，nmol/L）	450±120	500±130	t=－2.140	0.035
加压素前体肽（ $x ¯$ ±s，pmol/L）	12.5±3.2	15.0±4.0	t=－3.873	＜0.001
中性粒细胞计数（ $x ¯$ ±s，×10⁹/L）	3.2±1.0	4.2±1.8	t=－3.606	＜0.001
单核细胞计数（ $x ¯$ ±s，×10⁹/L）	0.3±0.1	0.3±0.1	t=－1.026	0.307
淋巴细胞 [M（P₂₅，P₇₅），×10⁹/L）]	1.1（0.6，1.8）	0.9（0.5，1.5）	Z=1.647	0.100
白蛋白（ $x ¯$ ±s，g/L）	28.6±5.3	37.5±6.5	t=－7.917	＜0.001
凝血酶原时间活性（ $x ¯$ ±s，%）	69.4±14.2	70.1±13.6	t=－0.277	0.782
天冬氨酸氨基转移酶 [M（P₂₅，P₇₅），IU/L]	33.0（24.0，50.0）	31.0（22.0，47.0）	χ²=0.525	0.600
丙氨酸氨基转移酶（ $x ¯$ ±s，IU/L）	30.1±2.5	29.9±2.6	t=0.424	0.672
血清胆红素（ $x ¯$ ±s，mg/dl）	3.5±1.2	2.5±0.8	t=4.923	＜0.001
凝血酶原时间延长值（ $x ¯$ ±s，s）	5.0±1.5	3.0±1.0	t=8.120	＜0.001
腹水 [例（%）]	30（53.6）	20（35.7）	χ²=3.733	0.053
Child-Pugh分级 [例（%）]			χ²=－1.994	0.043
A级	20（35.7）	30（53.6）
B级	25（44.6）	20（35.7）
C级	11（19.6）	6（10.7）

变量	β值	S.E.值	Z值	P值	HR值	95%CI
性别（男 vs. 女）	0.11	0.44	0.26	0.799	1.12	0.47～2.67
年龄（岁）	0.03	0.02	1.76	0.078	1.03	1.00～1.07
BMI（kg/m²）	－0.06	0.05	－1.32	0.187	0.94	0.86～1.03
C-反应蛋白（mg/L）	0.05	0.02	2.45	0.014	1.05	1.01～1.09
白细胞计数（×10⁹/L）	0.08	0.06	1.26	0.208	1.08	0.96～1.22
血清游离皮质醇（nmol/L）	0.00	0.00	0.91	0.363	1.00	1.00～1.00
加压素前体肽（pmol/L）	0.10	0.06	1.58	0.114	1.10	0.98～1.24
中性粒细胞计数（×10⁹/L）	0.10	0.09	1.11	0.267	1.11	0.92～1.33
单核细胞计数（×10⁹/L）	0.17	0.07	2.68	0.007	1.19	1.05～1.35
淋巴细胞计数（×10⁹/L）	－0.40	0.18	－2.21	0.027	0.67	0.47～0.96
白蛋白（g/L）	－0.07	0.03	－2.61	0.009	0.93	0.88～0.98
凝血酶原时间活性（%）	－0.01	0.01	－1.20	0.230	0.99	0.97～1.01
天冬氨酸氨基转移酶（U/L）	0.01	0.01	1.20	0.230	1.01	1.00～1.02
丙氨酸氨基转移酶（U/L）	0.00	0.01	0.60	0.549	1.00	0.99～1.01
血清总胆红素（mg/dl）	0.25	0.09	2.91	0.004	1.28	1.08～1.51
腹水（有 vs. 无）	0.70	0.44	1.59	0.111	2.02	0.85～4.80
Child-Pugh分级（每升高1级）	0.96	0.30	3.15	0.002	2.61	1.44～4.73
标准化CALLY指数（每升高1 SD）	－0.81	0.41	－1.96	0.050	0.44	0.20～1.00

变量	β值	S.E.值	Z值	P值	HR值	95%CI
单核细胞计数（×10⁹/L）	0.17	0.07	2.36	0.018	1.18	1.03～1.36
Child-Pugh分级	0.77	0.36	2.14	0.032	2.17	1.07～4.40
标准化CALLY指数	－0.37	0.43	－0.87	0.386	0.69	0.30～1.60

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