Prognostic Significance of the C-Reactive Protein–Albumin–Lymphocyte İndex and The Pan-İmmune-İnflammation Value in İschemic and Hemorrhagic Stroke: A Comparative Analysis of Subtypes

Abstract

Background: Cerebrovascular events are major causes of global mortality and disability. Inflammation, immune response, and nutritional status play crucial roles in stroke pathophysiology. The C-reactive protein–albumin–lymphocyte (CALLY) index and the pan-immune-inflammation value (PIV) are novel composite biomarkers reflecting these mechanisms. This study compared their prognostic performance between ischemic and hemorrhagic stroke. Methods: This retrospective, single-center cohort included 357 patients diagnosed with ischemic or hemorrhagic stroke between January 2020 and December 2024. Demographic, clinical, and laboratory data were retrieved from electronic records. Indices including CALLY, PIV, HALP, SII, and MII were calculated from blood samples obtained within 24 h of admission. Group comparisons, multivariate logistic regression, and receiver operating characteristic (ROC) analyses identified independent predictors and diagnostic performance. Results: Among 357 patients (mean age 67 ± 14 years; 56.6% ischemic, 43.4% hemorrhagic), the CALLY index was significantly higher in hemorrhagic cases (p < 0.001). Multivariate analysis identified CALLY (odds ratio = 1.255), PIV (odds ratio = 1.001), and HALP (odds ratio = 1.258) as independent predictors (all p < 0.001). CALLY showed the highest discriminative ability (area under the ROC curve = 0.756). In hemorrhagic stroke, lower CALLY values were associated with in-hospital mortality (AUC = 0.646, p = 0.002). Conclusion: The CALLY index demonstrated superior prognostic value compared with other inflammatory markers and may serve as a simple, low-cost tool for early stroke risk assessment. Prospective, multicenter studies are warranted to validate these findings and to establish standardized cutoff values.