Predicting intestinal ischemia in mechanical intestinal obstruction: the role of the C-reactive protein-albumin-lymphocyte index.

backgroundIntestinal ischemia requiring bowel resection is a serious complication of mechanical intestinal obstruction, and early identification of patients with irreversible ischemic injury remains challenging. Albumin-based immunonutritional indices, including the C-reactive protein-albumin-lymphocyte (CALLY) index, Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS), may reflect systemic inflammation, nutritional reserve, and immune status. This study aimed to evaluate the prognostic value of these indices for predicting bowel resection due to irreversible ischemic injury in patients undergoing surgery for non-malignant mechanical intestinal obstruction.

methodsWe retrospectively analyzed data from 680 adult patients admitted with mechanical intestinal obstruction between January 2017 and July 2025. After excluding patients with malignancy-related obstruction, 464 patients with non-malignant mechanical intestinal obstruction were included in the final analysis. Patients were categorized according to bowel resection status. Demographic characteristics, laboratory parameters, inflammatory and immunonutritional indices, and clinical outcomes were recorded. Separate preoperative multivariate logistic regression models were constructed to avoid mathematical overlap and multicollinearity among related indices. Diagnostic performance was assessed using receiver operating characteristic curve analysis.

resultsThe final cohort comprised 300 patients who did not undergo bowel resection and 164 who required bowel resection. Patients in the resection group exhibited higher inflammatory marker levels and lower nutritional and immune-related indices. In the conventional preoperative model, C-reactive protein (CRP) was positively associated with bowel resection, whereas albumin level and lymphocyte count were inversely associated with this outcome. In separate index-based models, a CALLY index ≤2.77, lower PNI values, and an mGPS of 2 were independently associated with bowel resection. The CALLY index demonstrated moderate discriminatory performance with an area under the curve (AUC) of 0.744. However, pairwise AUC comparisons revealed no significant discriminatory advantage of the CALLY index over PNI or the C-reactive protein-albumin ratio (CAR).

conclusionPreoperative inflammatory and immunonutritional markers were associated with bowel resection due to irreversible ischemic injury in patients with non-malignant mechanical intestinal obstruction. The CALLY index was independently associated with bowel resection and demonstrated moderate discriminatory performance; however, it was not superior to PNI or CAR. These indices may serve as adjunctive tools within a broader preoperative risk assessment framework rather than as standalone decisionmaking tools. Prospective multicenter studies are needed to externally validate the proposed cutoff values and the performance of these markers.