The predictive value of albumin-based nutritional indices for intestinal ischemia in strangulated abdominal wall hernias: an insight into the novel CALLY Index.

PURPOSE

Intestinal ischemia in strangulated abdominal wall hernias is a life-threatening condition that requires early detection and timely intervention. Since both systemic inflammation and nutritional status play a crucial role in surgical outcomes, identifying reliable predictive markers is essential. This study explores the potential of albumin-based nutritional indices-the CALLY Index, Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS)-to assess their ability to predict the risk of intestinal ischemia and the need for surgical resection.

METHODS

We retrospectively analyzed 125 patients who underwent surgery for incarcerated abdominal hernias between January 2015 and August 2024. Patients were categorized based on whether they had intestinal or omental ischemia. Key demographic data, perioperative findings, and laboratory parameters-including CRP, albumin, lymphocyte count, PNI, CALLY, and mGPS-were recorded. We performed univariate and multivariate regression analyses to identify independent risk factors, while ROC analysis was used to determine the optimal cutoff value for the CALLY Index.

RESULTS

Out of 125 patients, 66 (52.8%) were female, and the median age was 67 (58-76) years. Intestinal ischemia was found in 73 (58.4%) of the patients, while 23 (18.4%) had only omental necrosis. In the multivariate regression analysis, GPS 2 (OR: 19.299, p = 0.015) and CALLY < 2.5 (OR: 5.397, p = 0.017) were identified as independent predictors of intestinal ischemia. ROC analysis showed that a CALLY value below 2.5 had strong predictive power (AUC: 0.828, 95% CI: 0.753-0.902, p < 0.001).

CONCLUSION

Our findings suggest that the CALLY Index and mGPS are valuable tools for predicting intestinal ischemia in strangulated abdominal hernias. By incorporating inflammatory and nutritional markers into risk assessment, these indices can assist in early diagnosis and timely surgical decision-making.