{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:12:56Z","timestamp":1779358376630,"version":"3.51.4"},"reference-count":20,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Vaginal cuff hematoma is a recognized complication following hysterectomy, with a subset of patients requiring invasive intervention. No reliable bedside biomarker currently exists to identify at admission patients likely to fail conservative management. This study aimed to evaluate the incidence and clinical characteristics of symptomatic vaginal cuff hematoma across all hysterectomy approaches, and to assess the predictive performance of the CALLY index (CRP-albumin-lymphocyte index), a composite marker of inflammatory burden, immune function, and nutritional status, alongside the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for identifying patients requiring interventional management. Methods: This retrospective cohort study included 61 patients with symptomatic vaginal cuff hematoma following hysterectomy in a major tertiary referral center (November 2022\u2013July 2025). Patients were divided into conservative (n = 38) and interventional (n = 23) management groups. The CALLY index was calculated as [Albumin (g\/dL) \u00d7 Lymphocyte (\u00d7109\/L)] \u00f7 [CRP (mg\/L) \u00d7 10\u22122]. Receiver operating characteristic (ROC) curve analysis with the DeLong method was used to compare predictive performance. Results: The overall incidence of symptomatic vaginal cuff hematoma was 1.9% (73\/3852 hysterectomies), with the highest rate following vaginal hysterectomy (3.32%) and the lowest after robotic hysterectomy (0.74%). Interventional management was required in 37.7% of patients. The interventional group had significantly higher CRP (192 vs. 62 mg\/L, p &lt; 0.001), NLR (7.53 vs. 4.17, p &lt; 0.001), and SII (2308 vs. 1207, p &lt; 0.001), and significantly lower CALLY index values (2.00 vs. 9.80, p &lt; 0.001). The CALLY index demonstrated the highest predictive performance (AUC = 0.863, 95% CI: 0.762\u20130.964), outperforming SII (AUC = 0.801), NLR (AUC = 0.789), and PLR (AUC = 0.654). At the optimal cutoff of \u22642.89, the CALLY index yielded a sensitivity of 65.2% and a specificity of 92.1%. Conclusions: The CALLY index is a simple, routinely available composite biomarker that may help identify patients at higher risk for interventional management in symptomatic vaginal cuff hematoma. Its incorporation into postoperative assessment may improve risk stratification and support timely clinical decision-making.<\/jats:p>","DOI":"10.3390\/diagnostics16101561","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T09:29:58Z","timestamp":1779355798000},"page":"1561","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive Value of the CALLY Index for Interventional Management in Vaginal Cuff Hematoma Following Hysterectomy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-8943","authenticated-orcid":false,"given":"Candost","family":"Hanedan","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0650-3091","authenticated-orcid":false,"given":"Ay\u015fe Nur","family":"\u0130nal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ay\u015fe","family":"Yi\u011fit","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9159-7476","authenticated-orcid":false,"given":"O\u011fuz Kaan","family":"K\u00f6ksal","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-925X","authenticated-orcid":false,"given":"\u015eahin Kaan","family":"Baydemir","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5578-8718","authenticated-orcid":false,"given":"Neslihan","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9407-2704","authenticated-orcid":false,"given":"Hande Nur","family":"\u00d6nc\u00fc","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2102-3183","authenticated-orcid":false,"given":"G\u00f6k\u00e7en","family":"Ege","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aysu Ye\u015fim","family":"Tezcan","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuba Zengin","family":"Aksel","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vakkas","family":"Korkmaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lokman Hekim University, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c7a\u011fanay","family":"Soysal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, 06790 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"611.e1","DOI":"10.1016\/j.ajog.2022.06.028","article-title":"Trends and predictors of hysterectomy prevalence among women in the United States","volume":"227","author":"Harvey","year":"2022","journal-title":"Am. 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