Clinical significance of controlling nutritional status score (CONUT) in evaluating outcome of postoperative patients with gastric cancer

Xiao, Qi; Li, Xiaoqing; Duan, Baojun; Li, Xiaofan; Liu, Sida; Xu, Boyu; Shi, Shuai; Zhang, Jin; Qin, Haoyuan; Duan, Xianglong; Pu, Yansong

doi:10.1038/s41598-021-04128-4

“…Clinical data, including demographic information, medical history, laboratory tests, postoperative complications, lengths of hospital stay (LOS), and cost were collected and analyzed. Postoperative complications (PPC) were graded according to the Clavien-Dindo (CD) classification [15], and grade II or higher were regarded as complications [16].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

Zhao

¹

,

Liu

²

,

Wang

³

et al. 2022

Applied Bionics and Biomechanics

3

0

1

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Objective. Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer patients. The study is aimed at investigating the prevalence of malnutrition, perioperative nutritional support, and the risk factors associated with delayed discharge of geriatric patients undergoing gastrectomy. Methods. A retrospective study of gastric cancer patients ( age ≥ 65 ) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management, were collected and analyzed. Postoperative complications were assessed according to the Clavien-Dindo grading system, and the prognostic nutritional index (PNI) was calculated. The risk factors affecting the prolongation of postoperative hospital stay were analyzed. Results. A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The albumin, prealbumin, and hemoglobin levels were lower in the malnutrition group than in the well-nourished group. The proportion of patients who received preoperative total parenteral nutritional support in the malnutrition group was significantly higher than in the well-nourished group (12.4% vs. 3.7%, P < 0.001 ). All patients received postoperative parenteral nutrition (PN); the proportion of patients who received total nutrient admixture (TNA) in the malnutrition group was lower than in the well-nourished group (22.1% vs. 33.5%, P = 0.001 ). No significant difference was found in the duration of postoperative nutrition between groups ( P > 0.05 ). The malnutrition group was associated with a higher rate of postoperative complications ( P < 0.001 ). Univariate and multivariate regressions revealed that age > 70 years ( OR = 1.216 , 95% CI 1.048-1.411, P = 0.010 ), operation time > 180 min ( OR = 1.431 , 95% CI 1.237-1.656, P < 0.001 ), PNI < 44.5 ( OR = 1.792 , 95% CI 1.058-3.032, P = 0.030 ), and postoperative complications ( OR = 2.191 , 95% CI 1.604-2.991, P < 0.001 ) were significant risk factors associated with delayed discharge. Conclusion. Malnutrition is relatively common in elderly patients undergoing gastrectomy. Advanced age, duration of surgery, lower levels of PNI, and postoperative complications were risk factors associated with delay discharge. Elderly gastric cancer patients with risk factors urgently require specific attention for reducing hospital stay.

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“…All the above issues tend to aggravate the malnutrition state of the patient, forming a vicious circle. Xiao et al reported that nutritional deficiencies following gastric cancer surgery directly impact the treatment effect of patients and can easily lead to adverse clinical outcomes (22). In this study, the timepoint of three months after surgery was selected as the period for assessment of malnutrition and as the basis for grouping.…”

Section: Discussionmentioning

confidence: 99%

Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study

Tian¹,

Wu²,

Tang³

et al. 2023

J Gastrointest Oncol

4

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Background: This study analyzed both the influencing factors of malnutrition in patients with gastric cancer and established a multi-dimensional risk model to predict postoperative malnutrition three months after surgery. Methods:The clinical data of gastric cancer patients hospitalized for the first time and receiving laparoscopic surgery in the general surgery department of our hospital were retrospectively analyzed through the hospital information system and divided into a training set and a validation set in the ratio of 7:3. Nutritional status was assessed using the Patient Generated Subjective Global Assessment scale and follow-up records three months after surgery. Patients were divided into a non-malnutrition group and a malnutrition group, and a risk prediction model was established and displayed in the form of a nomogram. Results: A total of 344 patients were included, with 242 in the training and 102 in the validation set. Tumor node metastasis stage (TNM Stage, P=0.020), cardiac function grading (CFG, P=0.013), prealbumin (PAB, P<0.001), neutrophil-to-lymphocyte ratio (NLR, P=0.027), and enteral nutrition within 48 hours post-operation (EN 48h post-op, P=0.025) were independent risk factors. We established a prediction model with the above variables and displayed it via a nomogram, then verified its effectiveness through internal and external verification. This revealed a C-index of 0.84 (95% CI: 0.79-0.89), and the area under curve (AUC) areas of 0.840 (training set) and 0.854 (validation set), which was better than the nutritional risk screening 2002 (NRS2002) scale. The calibration curve brier scores were 0.159 and 0.195, and the Hosmer-Lemeshow test chi-square values were 14.070 and 1.989 (P>0.05). The decision curve analysis (DCA) of the training set model indicated the clinical applicability was good and within the threshold probability range of 10%-85%, which was also better than NRS2002. Conclusions: A clinical prediction model including multi-dimensional variables was established based on independent risk factors of malnutrition three months after gastrectomy in patients with gastric cancer. The model yields greater prediction accuracy of the risk of three-month-postoperative malnutrition in patients with gastric cancer, helps screen high-risk patients, formulates targeted nutritional prescriptions early, and improves the overall prognosis of patients.

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“…Although malnutrition has been investigated with increasing interest in recent years, it is one of the hallmarks of frailty 6,8,9,13,14 . Initially, several scores were developed related to malnutrition, which was associated with poor clinical outcomes in cancer patients 8,15,16 . Additionally, malnutrition has also been associated with mortality, morbidity, and disease severity in cardiovascular disease 6,10,13,14,17–21 .…”

Section: Discussionmentioning

confidence: 99%

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

Demirci,

Aslan,

Güner

et al. 2023

Cathet Cardio Intervent

4

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BackgroundOne of the hallmarks of frailty in patients with severe aortic stenosis (AS) is malnutrition, for which one of the most up‐to‐date scoring systems is the Naples prognostic score (NPS). This study sought to investigate the predictive role of the NPS in determining mortality in patients undergoing transcatheter aortic valve replacement (TAVR) under long‐term follow‐up.MethodsA total of 430 consecutive patients with symptomatic severe AS who underwent TAVR were included retrospectively. The primary endpoint of the study was the long‐term all‐cause mortality. The study population was divided into two groups according to the NPS value, including Group 1 (NPS 0–2) and Group 2 (NPS 3–4).ResultsThe all‐cause mortality occurred in 250 patients (62.5%) patients during a follow‐up time of 40.6 (22.0–69.4) months. During the follow‐up period, all‐cause mortality was higher in Group 2 compared with Group 1 (87.9% vs. 42.9%, p < 0.001). Older age (p < 0.001), chronic obstructive pulmonary disease (p = 0.015), left ventricular ejection fraction (p = 0.021), and being in Group 2 (high NPS) (hazard ratio: 7.058, 95% confidence interval: 5.174–9.629, p < 0.001) were found to be independent predictors of all‐cause mortality at long‐term follow‐up.ConclusionThe NPS as a malnutrition and inflammation marker in patients with severe aortic stenosis who underwent TAVR provides valuable information for all‐cause mortality under long‐term follow‐up.

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Clinical significance of controlling nutritional status score (CONUT) in evaluating outcome of postoperative patients with gastric cancer

Cited by 22 publications

References 31 publications

Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

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