The Association Between the C-Reactive Protein-to-Albumin-to-Lymphocyte (CALLY) Index and Retinopathy: Insights from a Population-Based Study

Pingping Li ¹ Fangyu Chen ² Lu Li ¹ Wu Jianhua ^2*

• ¹ Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
• ² Wuhan Aier Eye Hospital, Wuhan, Hebei Province, China

Retinopathy is a multifactorial disease involving metabolism, immunity, inflammation, and other factors. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immunonutritional score, but its predictive value for retinopathy remains to be elucidated. Using data from 5,439 participants in the 2005-2008 National Health and Nutrition Examination Survey (NHANES), the CALLY index was calculated as the ratio of albumin to lymphocyte, divided by C-reactive protein (CRP) multiplied by 10⁴, while retinopathy was diagnosed through professional grading of fundus photographs. Multivariable-weighted logistic regression revealed a significant inverse association between the CALLY index and retinopathy risk (OR = 0.96, 95% CI = 0.94-0.98, P = 0.002), with the highest CALLY index quartile corresponding to a markedly lower risk (P < 0.001). Compared to other inflammatory markers, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR), the CALLY index demonstrated superior predictive performance (AUC = 0.672, 95% CI = 0.643-0.701). Mediation analysis indicated that high-density lipoprotein (HDL) levels partially mediated the association between the CALLY index and retinopathy. These findings highlight the CALLY index as a reliable, independent biomarker for retinopathy risk assessment, outperforming traditional inflammatory markers and offering potential clinical value for early identification of retinopathy in individuals with chronic diseases.