CRP-To-Albumin Ratio and CALLY Index for Sepsis Identification and Mortality Discrimination in Critically…

Cohort studyPediatrics international : official journal of the Japan Pediatric Society· 2026

CRP-To-Albumin Ratio and CALLY Index for Sepsis Identification and Mortality Discrimination in Critically Ill Children.

Gürkan Atay, Seher Erdoğan, İlknur Pençe … Dilara Kurt

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PediatricsCohort studyDiagnosisQ3IF 0.7

CRP-to-albumin ratio shows highest accuracy for identifying sepsis in critically ill children

CRP-To-Albumin Ratio and CALLY Index for Sepsis Identification and Mortality Discrimination in Critically Ill Children.

Gürkan Atay … Dilara Kurt

Pediatrics international · 2026 · Q3 in Pediatrics

Background

We compared the diagnostic and prognostic performance of the C-reactive protein-to-albumin (CRP/alb) ratio, neutrophil-to-albumin ratio (neutrophil-to-albumin ratio), and C-reactive protein-albumin-lymphocyte (CALLY) index in critically ill children.

Methods

This retrospective study included 302 children (1 month-18 years) admitted to a PICU between 2023 and 2025.

n = 302 children

Results

AUC of 0.868 for detecting sepsis; 1.0 is perfect, 0.5 is chance.

AOR by subgroup · 95% CI

More results

Mortality was 19.2%; 43.0% had sepsis.

For mortality, CRP/alb (AUC 0.757), CRP (AUC 0.751), and CALLY (AUC 0.743) demonstrated similar discrimination (all p > 0.05).

Lower CALLY values independently predicted sepsis (aOR 0.94; 95% CI 0.90-0.98; p = 0.002).

More results

The CRP/alb ratio (aOR 1.17 per 10-unit increase; 95% CI 1.06-1.29; p = 0.002) and lactate (aOR 1.34; 95% CI 1.16-1.55; p < 0.001) independently predicted mortality.

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Conclusion · 1 of 2

The CRP/alb ratio showed higher discrimination for sepsis than the CALLY index and was the only composite index independently associated with mortality. However, reclassification analyses did not support incremental value beyond CRP alone.

Conclusion · 2 of 2

Composite indices showed comparable rather than additive performance relative to CRP in this population.

CRP-To-Albumin Ratio and CALLY Index for Sepsis Identification and Mortality Discrimination in Critically Ill Children.

CRP-To-Albumin Ratio and CALLY Index for Sepsis Identification and Mortality Discrimination in Critically Ill Children.

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