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cohort·internal medicine, gastroenterology, clinical nutrition, nutrition, epidemiology·PMC10057573

COntrolling NUTritional Status (CONUT) as Predictive Score of Hospital Length of Stay (LOS) and Mortality: A Prospective Cohort Study in an Internal Medicine and Gastroenterology Unit in Italy

Nutrients · 10 authors, 4 centres

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TL;DR

This prospective cohort study of 203 patients admitted to an Internal Medicine and Gastroenterology unit in Italy evaluated the CONUT nutritional screening score at admission.

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This prospective monocentric cohort study enrolled 203 patients admitted to an Internal Medicine and Gastroenterology Department in Italy. The CONUT score, based on serum albumin, total cholesterol, and total lymphocyte count, was assessed at admission. Patients with a CONUT score ≥ 5 had nearly 90% probability of a longer hospital length of stay compared to those with a lower score, a finding confirmed in multivariate analysis. Although in-hospital mortality events were limited to nine, univariate analysis and ROC curve analysis identified a CONUT score ≥ 9 as a predictive risk factor of in-hospital mortality. Early nutritional supplementation (within 48 hours of admission) was associated with a nearly 90% reduction in mortality risk. No difference in 30-day hospital re-admission was found between CONUT classes. Limitations include the monocentric design, small number of deaths precluding multivariable mortality analysis, lack of body composition data, and uninvestigated effects of statin therapy and hematological or infective diseases on CONUT components.

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cohort

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internal medicine

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ORIGINAL PAPER

PMC10057573

COntrolling NUTritional Status (CONUT) as Predictive Score of Hospital Length of Stay (LOS) and Mortality: A Prospective Cohort Study in an Internal Medicine and Gastroenterology Unit in Italy

Nutrients

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ABSTRACT

Abstract Background: Hospital malnutrition affects nearly 30% of patients in medical wards and correlates with worse outcomes. An early assessment is necessary to stratify the risk of short-term outcomes and mortality. The predictive role of COntrolling NUTritional status (CONUT) score in this context has not yet been elucidated in Western countries. We aimed to test CONUT at admission as a predictive score of hospital outcomes, in an Internal Medicine and Gastroenterology Department of an Italian Tertiary Care University hospital. Methods: We prospectively enrolled patients admitted to our center, stratifying them into the four CONUT classes (normal = 0–1; mild = 2–4; moderate = 5–8; severe = 9–12 points) according to serum albumin (g/dL), total lymphocyte count (/mm 3 ), and total cholesterol (mg/dL); the primary outcome measure was length of stay (LOS) and the secondary one was in-hospital mortality. Results: Out of a total of 203 patients enrolled, 44 (21.7%) patients had a normal status (0–1), 66 (32.5%) had a mild impairment (2–4), 68 (33.5%) had a moderate impairment (5–8), and 25 (12.3%) a severe impairment (9–12). The mean LOS was 8.24 ± 5.75 days; nine patients died. A moderate-severe CONUT correlated with a higher LOS at the univariate [HR 1.86 (95% CI 13.9–3.47); p < 0.0001] and multivariate analysis [HR 1.52 (95% CI 1.10–2.09); p = 0.01]. The CONUT score was also a predictor of mortality, with an AUC of 0.831 (95% CI 0.680–0.982) and with an optimal cut-off at 8.5 points. Nutritional supplementation within 48 h from admission correlated with lower mortality [OR 0.12 (95% CI 0.02–0.56) p = 0.006]. Conclusions: CONUT is a reliable and simple predictor of LOS and in-hospital mortality in medical wards. Keywords: CONUT, disease-related malnutrition, length of stay, mortality, nutritional support, refeeding syndrome

CITATION EXPORT

Emanuele Rinninella, Raffaele Borriello, Marco D’Angelo et al.. COntrolling NUTritional Status (CONUT) as Predictive Score of Hospital Length of Stay (LOS) and Mortality: A Prospective Cohort Study in an Internal Medicine and Gastroenterology Unit in Italy. Nutrients. (2023). https://doi.org/10.3390/nu15061472

AUTHORS

10 · 4 CENTRES

Emanuele Rinninella, Raffaele Borriello, Marco D’Angelo, Tiziano Galasso, Marco Cintoni, Pauline Raoul, Michele Impagnatiello, Brigida Eleonora Annicchiarico, Antonio Gasbarrini, Maria Cristina Mele

1Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy; [email protected] (E.R.); [email protected] (A.G.); [email protected] (M.C.M.)
2UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; [email protected]
3Scuola di Specializzazione in Medicina Interna, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy; [email protected] (R.B.); [email protected] (M.D.); [email protected] (T.G.)
4UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; [email protected] (M.I.); [email protected] (B.E.A.)