Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis

Abstract

BackgroundAs defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD).MethodsObservational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase.ResultsOf 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15–1.27], I2 = 0%), (1.53 [95% CI: 1.26–1.84], I2 = 84%), and (2.24 [95% CI: 1.57–3.19], I2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44–2.03], I2 = 0%) and severe (aHR 2.66 [95% CI: 1.82–3.89], I2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively.ConclusionAs defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.

Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis

“…While when used as a continuous variable, incremental increase in PNI was associated with 9 and 16% decrease in mortality and MACE rates, respectively. These results are in congruence with other malnutrition assessment tools used in CAD patients thereby indicating the PNI can be readily used for risk-stratification of these patients ( 31 , 33 ). Except for the results of MACE (as categorical variable), all other results maintained their statistical significance on sensitivity analysis.…”

“…A wide variety of malnutrition tools have been used in literature for CAD patients and there is no consensus on which is a better tool. Arero et al ( 31 ) recently pooled data from nine studies and found that malnutrition in CAD patients as defined by the Controlling Nutrition Status (CONUT) score could independently predict mortality and MACE. Similarly, Xue et al ( 32 ) in a meta-analysis found sarcopenia to be predictive of adverse outcomes in CAD patients.…”

Association between Controlling Nutritional Status Score and Severity of Coronary artery stenosis in elderly patients

“…After follow-up of 58.5 ± 35.8 months, the CONUT score was independently associated with the incidence of myocardial infarction, cardiovascular death, congestive heart failure and major adverse cardiovascular event (MACE) [21]. A meta analysis analysis nine observational studies with 81,257 CAD patients.they found that per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively [7].…”

“…It re ects the protein reserves, calories consumed and immune defense states. Several studies have proved that CONUT score was associated with the poor outcome of CAD patients,which indicated malnutrition is an independent predictor of major adverse cardiovascular events in CAD patients [7,8]. However, the relationship between CONUT score and the severity of coronary artery stenosis has not yet been fully elucidated.…”

Predictive Risk Factors Associated with Severe Radiation-Induced Mucositis in Nasopharyngeal or Oropharyngeal Cancer Patients: A Retrospective Study

“…Lymphocytes require host immunocompetence and lymphocyte counts may reflect nutritional status. In fact, the controlling Nutritional Status (CONUT) score, a screening tool for evaluating malnutrition, takes into account serum albumin, total cholesterol, and total lymphocyte levels [ 25 ]. As such, the relationship between lymphocyte count and nutrition may explain the therapeutic benefits of oral glutamine supplementation in preventing and ameliorating radiation-induced oral mucositis among patients with head and neck cancer, as described previously [ 26 ].…”