The prognostic value of the CALLY index in sepsis: a systematic review and meta-analysis

Background The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker of inflammation, nutrition, and immunity, yet its prognostic value in sepsis remains uncertain due to inconsistent evidence. This meta-analysis seeks to clarify the relationship between the CALLY index and prognosis in septic patients. Methods A systematic search of PubMed, Embase, OVID, Web of Science, the China National Knowledge Infrastructure, the Wanfang Database, Google Scholar, and Baidu Scholar was conducted up to November 15, 2025. Studies reporting on the CALLY index’s association with mortality or its levels in sepsis survivors versus non-survivors were included. Data were pooled using standardized mean differences (SMDs), hazard ratios (HRs), and odds ratios (ORs) with 95% confidence intervals (CIs) under a random-effects model. Results This meta-analysis incorporated a total of six studies, encompassing seven cohorts and comprising 3,848 patients with sepsis. Overall, the CALLY index did not significantly differ between survivors and non-survivors (pooled SMD = −0.22, 95% CI: −1.18 to 0.74). However, subgroup analyses revealed a marked divergence: a higher CALLY index was correlated with survival in Chinese cohorts (SMD = −1.04, 95% CI: −1.69 to −0.39), whereas it was associated with mortality in the Turkish cohort (SMD = 1.39, 95% CI: 1.02 to 1.75). Multivariate analysis further showed a significant association between a higher CALLY index and a lower mortality risk (HR = 0.48, 95% CI: 0.33–0.69). The diagnostic accuracy of the CALLY index for predicting mortality was moderate, with a pooled sensitivity of 0.59 and specificity of 0.77. Significant heterogeneity was observed across all pooled analyses. Conclusion The CALLY index shows promise as a low-cost sepsis biomarker, but its variable link to mortality across ethnic groups requires validation in large, multinational prospective studies. Systematic review registration Identifier: INPLASY2025120023. http://inplasy.com