Abstract:

Objective To investigate the association between the systemic immune-inflammation index （SII）， C-reactive protein-to-albumin ratio （CAR）， and C-reactive protein-albumin-lymphocyte （CALLY） index and acute exacerbations of gouty arthritis （GA）. Methods This study enrolled 63 patients with GA in the acute phase， 62 patients in clinical remission （absence of acute inflammatory signs such as joint erythema， swelling， and localized heat/pain）， and 62 healthy controls at the Third People's Hospital of Chengdu between February 2023 and May 2025. SII， CAR， and CALLY index levels were compared across the three groups. Logistic regression was used to identify risk factors for acute GA exacerbations. Receiver operating characteristic （ROC） curve analysis evaluated the diagnostic performance of these indices. Multiple linear regression assessed the association between the percentage changes （Δ%） in SII， CAR， and CALLY index following treatment and the change in Visual Analog Scale （VAS） pain scores （ΔVAS）. Results SII and CAR levels were progressively lower across the acute， remission， and healthy control groups （all P < 0.05）， whereas the CALLY index was progressively higher （all P < 0.05）. Logistic regression identified polyarticular involvement and elevated SII and CAR as independent risk factors for acute exacerbations， while regular urate-lowering therapy and a higher CALLY index were independently protective （all P < 0.05）. The CALLY index demonstrated superior diagnostic performance for distinguishing the acute from the remission phase （AUC = 0.861）， significantly outperforming SII （AUC = 0.731） and CAR （AUC = 0.736） （both P < 0.05）. Following treatment， SII and CAR levels significantly decreased， while the CALLY index increased in patients with acute GA （all P < 0.05）. After adjusting for age and baseline VAS， multiple linear regression identified Δ%SII， Δ%CAR， and Δ%CALLY as independent predictors of ΔVAS （all P < 0.05）. Conclusion Elevated SII and CAR， alongside a decreased CALLY index， characterize the acute phase of GA. All three biomarkers effectively track post-treatment inflammatory resolution and clinical improvement， with the CALLY index exhibiting the highest diagnostic accuracy for identifying acute GA exacerbations.

Key words: gouty arthritis, acute attack stage, systemic immune-inflammation index, C-reactive protein to albumin ratio, CALLY index