{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:04:58Z","timestamp":1784174698906,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"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: Cytomegalovirus (CMV) reactivation is a clinically important complication in patients with active ulcerative colitis (UC) and has been associated with severe disease activity, treatment refractoriness, and adverse outcomes. The C-reactive protein\u2013albumin\u2013lymphocyte (CALLY) index is a composite biomarker reflecting systemic inflammation, nutritional status, and immune competence. However, its potential role in identifying patients with tissue-confirmed CMV colitis in UC has not been investigated. Methods: This retrospective, single-center cross-sectional study included 82 adults with active ulcerative colitis who underwent tissue evaluation for CMV infection between January 2018 and October 2023. CMV positivity was defined by histopathological and\/or immunohistochemical confirmation of CMV infection in colonic biopsy specimens. The CALLY index was calculated as serum albumin \u00d7 absolute lymphocyte count\/C-reactive protein. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance, and logistic regression analyses were used to identify independent predictors of tissue-confirmed CMV colitis. Results: Eighty-two patients were included, of whom 28 (34.1%) had tissue-confirmed CMV colitis. CMV-positive patients were older and had higher Mayo scores, more extensive disease, lower serum albumin levels, and higher fecal calprotectin concentrations than CMV-negative patients. Although median CALLY index values were numerically higher in CMV-positive patients, the difference did not reach statistical significance (p = 0.136). ROC analysis demonstrated modest discriminative performance for the CALLY index (AUC = 0.601, 95% CI: 0.472\u20130.722). The optimal CALLY cut-off value of 2838 was derived from the present dataset using the Youden index and yielded a sensitivity of 82.1% and a specificity of 50.0%. In multivariable logistic regression analysis, CALLY \u2265 2838 remained independently associated with tissue-confirmed CMV colitis (OR = 32.09, 95% CI: 3.27\u2013315.39, p = 0.003). Conclusions: The CALLY index demonstrated limited standalone diagnostic performance for identifying CMV colitis in active UC. However, a CALLY value \u2265 2838 was independently associated with tissue-confirmed CMV positivity and may provide complementary information for risk stratification alongside established clinical and inflammatory markers.<\/jats:p>","DOI":"10.3390\/diagnostics16142202","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:05:58Z","timestamp":1784077558000},"page":"2202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index and Tissue-Confirmed Cytomegalovirus Colitis in Patients with Active Ulcerative Colitis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-2384","authenticated-orcid":false,"given":"Mehmet Kursad","family":"Keskin","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tufan","family":"Teker","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0864-4989","authenticated-orcid":false,"given":"\u0130mran","family":"Sa\u011fl\u0131k","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrin","family":"U\u011fra\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Pathology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-8963","authenticated-orcid":false,"given":"Fatih","family":"Eren","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut Enver","family":"Dolar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1093\/ibd\/izz147","article-title":"Opportunistic infections are more common in Crohn\u2019s disease and ulcerative colitis: A large population-based study","volume":"26","author":"Sheriff","year":"2020","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Soni, K., and Puing, A. (2025). Cytomegalovirus colitis in adults with inflammatory bowel disease. Viruses, 17.","DOI":"10.3390\/v17060752"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2718","DOI":"10.1097\/MIB.0000000000000489","article-title":"Antiviral therapy in steroid-refractory ulcerative colitis with cytomegalovirus: Systematic review and meta-analysis","volume":"21","author":"Shukla","year":"2015","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1097\/MIB.0000000000000675","article-title":"Risk factors and clinical outcomes associated with cytomegalovirus colitis in patients with acute severe ulcerative colitis","volume":"22","author":"Lee","year":"2016","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Qin, Y., Wang, G., Kong, D., Li, G., Wang, H., Qin, H., and Wang, H. (2021). Risk factors of cytomegalovirus reactivation in ulcerative colitis patients: A meta-analysis. Diagnostics, 11.","DOI":"10.3390\/diagnostics11111952"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Jentzer, A., Veyrard, P., Roblin, X., Saint-Sardos, P., Rochereau, N., Paul, S., Bourlet, T., Pozzetto, B., and Pillet, S. (2020). Cytomegalovirus and inflammatory bowel diseases (IBD) with a special focus on the Link with ulcerative colitis (UC). Microorganisms, 8.","DOI":"10.3390\/microorganisms8071078"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1002\/ibd.21275","article-title":"Cytomegalovirus in inflammatory bowel disease: Pathogen or innocent bystander?","volume":"16","author":"Lawlor","year":"2010","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1111\/apt.13124","article-title":"Review article: Cytomegalovirus and inflammatory bowel disease","volume":"41","author":"Sager","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3904\/kjim.2017.087","article-title":"Approach to cytomegalovirus infections in patients with ulcerative colitis","volume":"32","author":"Park","year":"2017","journal-title":"Korean J. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Esen, S., Saglik, I., Dolar, E., Cesur, S., Ugras, N., Agca, H., Merdan, O., and Ener, B. (2024). Diagnostic utility of cytomegalovirus (CMV) DNA quantitation in ulcerative colitis. Viruses, 16.","DOI":"10.3390\/v16050691"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jcv.2018.06.002","article-title":"Novel score predicts risk for cytomegalovirus infection in ulcerative colitis","volume":"105","author":"Nowacki","year":"2018","journal-title":"J. Clin. Virol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s00595-024-02921-y","article-title":"Correlation between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index and the prognosis of gastric cancer patients after gastrectomy: A systematic review and meta-analysis","volume":"55","author":"Li","year":"2025","journal-title":"Surg. Today"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e37197","DOI":"10.1016\/j.heliyon.2024.e37197","article-title":"Associations of the C-reactive protein-albumin-lymphocyte (CALLY) index with cardiorenal syndrome: Insights from a population-based study","volume":"10","author":"Xu","year":"2024","journal-title":"Heliyon"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Yang, M., Lin, S.Q., Liu, X.Y., Tang, M., Hu, C.-L., Wang, Z.-W., Zhang, Q., Zhang, X., Song, M.-M., and Ruan, G.-T. (2023). Association between C-reactive protein-albumin-lymphocyte (CALLY) index and overall survival in patients with colorectal cancer: From the investigation on nutrition status and clinical outcome of common cancers study. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1131496"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lin, H., Bai, Z., Wu, Q., Chu, G., Zhang, Y., Guo, X., and Qi, X. (2022). Inflammatory indices for assessing ulcerative colitis severity and disease progression: A single-center retrospective study. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.851295"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5217\/ir.2020.00146","article-title":"Biomarker dynamics during infliximab rescue therapy in acute severe ulcerative colitis: CRP-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy","volume":"20","author":"Con","year":"2022","journal-title":"Intest. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1093\/ibd\/izaa088","article-title":"The ACE (Albumin, CRP and Endoscopy) index in acute colitis: A simple clinical index on admission that predicts outcome in patients with acute ulcerative colitis","volume":"27","author":"Grant","year":"2021","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"765","DOI":"10.4103\/njcp.njcp_616_22","article-title":"Cytomegalovirus reactivation: Early indicators in patients with ulcerative colitis","volume":"26","author":"Altunal","year":"2023","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yang, H., Wu, K., Zhang, H., Owyang, Q., Miao, Y., Gu, F., Hu, N., Zou, K., Sheng, J., and Li, J. (2020). IgA, albumin and eosinopenia as early indicators of cytomegalovirus infection in patients with acute ulcerative colitis. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01434-5"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Forte, E., Zhang, Z., Thorp, E.B., and Hummel, M. (2020). Cytomegalovirus latency and reactivation: An intricate interplay with the host immune response. Front. Cell. Infect. Microbiol., 10.","DOI":"10.3389\/fcimb.2020.00130"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mestrovic, A., Perkovic, N., Bozic, D., Kumric, M., Vilovic, M., and Bozic, J. (2024). Precision medicine in inflammatory bowel disease: A spotlight on emerging molecular biomarkers. Biomedicines, 12.","DOI":"10.3390\/biomedicines12071520"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1080\/00365521.2021.2006298","article-title":"The role of cytomegalovirus colitis on short- and long-term outcomes for patients with ulcerative colitis","volume":"57","author":"Zhang","year":"2022","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kawashima, K., Ishihara, S., Yuki, T., Fukuba, N., Oshima, N., Kazumori, H., Sonoyama, H., Yamashita, N., Tada, Y., and Kusunoki, R. (2016). Fecal calprotectin level correlated with both endoscopic severity and disease extent in ulcerative colitis. BMC Gastroenterol., 16.","DOI":"10.1186\/s12876-016-0462-z"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhang, J., Lin, Y., Zeng, J., Luo, G., Liao, P., Chen, Q., Zhong, H., Liang, S., Zhou, C., and Yang, B. (2025). The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index exhibits an L-shaped association with all-cause mortality in rheumatoid arthritis patients: A retrospective cohort study. BMC Rheumatol., 9.","DOI":"10.1186\/s41927-025-00499-7"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jakobsdottir, J., Gorin, M.B., Conley, Y.P., Ferrell, R.E., and Weeks, D.E. (2009). Interpretation of genetic association studies: Markers with replicated highly significant odds ratios may be poor classifiers. PLoS Genet., 5.","DOI":"10.1371\/journal.pgen.1000337"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2202\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:47:28Z","timestamp":1784173648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":25,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16142202"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16142202","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}