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

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 (/mm3), 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.

Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients

“…Some studies report a higher prevalence in males, while others indicate a greater risk of undernutrition in females [ 3 , 48 ]. However, other studies did not report differences in sex-related [ 5 , 43 ]. These different results could be influenced by differences in the study populations.…”

“…Malnutrition, especially among hospitalized older individuals, presents a multifaceted challenge with profound implications for health outcomes [ 1 ]. Beyond its conventional association with weight loss, malnutrition is linked to heightened risks, including nosocomial infections, prolonged hospital stays, disability, and, notably, mortality [ 2 , 3 , 4 , 5 ]. This intricate scenario is further complicated by inflammaging, a pro-inflammatory status associated with aging and shared in numerous pathological states [ 6 , 7 ].…”

“…The Controlling Nutritional Status (CONUT) score, a cost-effective and easily administered screening tool, displays notable efficacy in identifying disturbances in nutritional status and predicting various clinical outcomes in different hospitalized populations [ 5 , 28 , 31 ]. However, there is limited literature regarding its association with inflammatory status and body composition in the hospitalized elderly population.…”

Assessment of nutritional status and clinical outcomes: A comprehensive retrospective analysis of critically ill patients

“…[8] This scale has been used to predict severity and fatalities in various clinical disorders, most notably heart diseases, malignancies, stroke patients, and gastrointestinal diseases. [9–14]…”

Controlling Nutritional Status Score as a Predictor for Chronic Obstructive Pulmonary Disease Exacerbation Risk in Elderly Patients

“…It is based on a simple calculation from data collected by routine biochemical analysis and complete blood count that allows for assessing the nutritional status of the patient [9]. The CONUT score has a high prognostic value in specific populations such as the elderly, cancer patients, gastroenterological, or patients affected by heart failure or ischemic stroke [10,11]. In elderly patients, the CONUT score has demonstrated a high predictive value for a longer length of stay (LOS) and a higher risk of in-hospital mortality without incurring additional costs because the parameters used are often included in routine lab tests performed upon patient admission [6,11].…”