Abstract
BACKGROUND: This study aimed to evaluate the prognostic value of the C-reactive protein-albumin-lymphocyte (CALLY) index, an inflammation-based score derived from C-reactive protein (CRP), albumin, and lymphocyte count, in predicting 30-day mortality in elderly patients with hip fractures. METHODS: A retrospective analysis was conducted on patients aged 65 years and older who were hospitalized with hip fractures between January 2022 and January 2025. Clinical and laboratory data were extracted from electronic medical records. The CALLY index was calculated using the formula: Albumin × Lymphocyte / CRP. The primary outcome was all-cause mortality within 30 days of admission. Receiver operating characteristic (ROC) analysis was used to assess the discriminative ability of the index, and multivariable logistic regression was performed to identify independent predictors of mortality. RESULTS: A total of 410 patients aged 65 years and older with surgically treated hip fractures were included. The 30-day mortality rate was 14.6% (n=60). The CALLY index was significantly lower in non-survivors than in survivors (median: 5.6 vs. 9.4, p<0.001). Receiver operating characteristic (ROC) analysis showed that the CALLY index had moderate predictive ability for 30-day mortality, with an area under the curve (AUC) of 0.788. At the optimal cutoff value of 7.5, sensitivity was 75% and specificity was 67%. In the multivariable logistic regression model, inclusion of the CALLY index improved overall discrimination, yielding an AUC of 0.962. Kaplan-Meier survival analysis also demonstrated significantly lower survival probability in patients with low CALLY scores (p<0.001). CONCLUSION: The CALLY index is a simple, accessible score that was independently associated with early mortality in elderly patients with hip fractures. It may help clinicians identify high-risk patients during the initial phase of hospitalization and inform perioperative management decisions.