PP070 - NUTRITIONAL-INFLAMMATORY INDICES PREDICT MORTALITY IN OLDER ADULTS WITH ACUTE GI BLEEDING: CALLY INDEX, NPAR, AND THE AMPLIFYING ROLE OF DEMENTIA

Linked sessions

PP070

NUTRITIONAL-INFLAMMATORY INDICES PREDICT MORTALITY IN OLDER ADULTS WITH ACUTE GI BLEEDING: CALLY INDEX, NPAR, AND THE AMPLIFYING ROLE OF DEMENTIA

M. Pehlivan1,*, M. Üçdal2, A. Uyar2, M. Eşme1, C. Balcı1, B. B. Doğu1, M. G. Halil1, M. Cankurtaran1

1Department of Internal Medicine, Division of Geriatrics, 2Department of Internal Medicine, Hacettepe University, Ankara, Türkiye

 

Rationale: Malnutrition and hypoalbuminaemia are prevalent in older adults with acute GI bleeding, yet existing risk scores fail to capture nutritional-inflammatory compromise [1,2]. The CALLY index (CRP-Albumin-Lymphocyte) and NPAR (Neutrophil Percentage-to-Albumin Ratio) integrate albumin-based nutritional reserve with inflammation; their interaction with dementia—which amplifies nutritional vulnerability—is unexplored [3].

Methods: We conducted a retrospective cohort study using the MIMIC-IV database (n=750, age ≥65y, acute GI bleeding, 2008-2019) [4]. CALLY and NPAR  were calculated from admission bloods; patients were stratified by age and dementia status. The primary outcome was 30-day mortality, analysed by multivariable logistic regression, ROC analysis, and bootstrap-validated risk stratification.

Results: Hypoalbuminaemia (<3.5 g/dL) in 73.1% (mean 2.8±0.6 g/dL) and anaemia in 81.6%. Dementia (21.3%) independently predicted mortality (OR 2.14), lower endoscopic rates (58.8% vs 72.0%), and worse CALLY profiles. Low CALLY (<0.25) predicted 30-day mortality (OR 3.42, 95%CI 2.04-5.74, AUC 0.78), outperforming NLR, PLR, PNI, FI-Lab. High NPAR (>18.5) predicted mortality (OR 2.28) and ICU admission. Patients >85y with dementia and low CALLY reached 38.5% vs 2.1% low-risk (AUC 0.82).

Image:



 

Conclusion: Nutritional-inflammatory depletion captured by CALLY and NPAR is the dominant prognostic axis in older GI bleeders, with dementia acting as a critical risk amplifier. These zero-cost indices support early identification of patients requiring nutritional intervention and goals-of-care discussions alongside haemostatic management.

References: 1. Barkun AN, et al. Ann Intern Med. 2019;171:805-822. 2. Soeters PB, et al. JPEN J Parenter Enteral Nutr. 2019;43:181-193. 3. Iida H, et al. HPB (Oxford). 2022;24:101-115. 4. Johnson AEW, et al. Sci Data. 2023;10:1.

Disclosure of Interest: None declared