The Nutritional Index 'CONUT' Is Useful for Predicting Long-Term Prognosis of Patients with End-Stage Liver Diseases

Abstract

Organ allocation in Japan remains difficult due to the shortage of deceased-donor livers. The screening tool for controlling nutritional status (CONUT) has been considered to be an established assessment model for evaluating nutritional aspects in surgical patients. However, the application of this CONUT for evaluating the prognosis of patients with end-stage liver diseases has not been evaluated. We assessed the predictability of the prognoses of 58 patients with end-stage liver disease using various prognostic models. The patients registered at the transplantation center of Tohoku University Hospital for the waiting list of Japan Organ Transplant Network for liver transplantation were retrospectively analyzed. The prognoses of the patients were evaluated using the following 5 models: CONUT, the model for ELD with incorporation of sodium (MELD-Na), Child-Turcotte-Pugh score (CTP), prognostic nutritional indices (Onodera: PNI-O), and the Japan Medical Urgency criteria of the liver (JMU). Cox's proportional hazard model, log-rank test and concordance(c)-static were used for the statistics. The indices were 17.74 ± 5.80 for MELD-Na, 9.21 ± 2.19 for CTP, 33.92 ± 11.16 for PNI-O, and 7.57 ± 3.09 for CONUT. Univariate analysis revealed the significance of CONUT (p = 0.017, Odds: 1.325) but not MELD-Na, CTP, JMU or PNI-O for prediction. The cumulative survival rate was clearly discriminated at CONUT point 7. The c-static was 0.081 for the 6-month (M) survival rate, 0.172 for 12M, 0.517 for 36M, 0.821 for 48M, and 0.938 for 60M for CONUT. In conclusion, CONUT shows best predictability for the distant prognoses of patients with ELD.

Exploration of Nutrition Support Team Outcome Predictors for Elderly

“…When patients are evaluated using CONUT, the consideration of score is important, in addition to the assessment of the level of under nutrition as determined using the original method. Although focusing on a different population, another study of terminal liver disease patients needing liver transplantation reported that the cumulative survival rate in patients with a CO-NUT score ≤ 7 was significantly higher than in patients with CONUT score ≥ 8 [27]. The cut off value in the previous study is nearly equal to that in our study.…”

Onodera's Prognostic Nutritional Index as a Risk Factor for Mortality in Peritoneal Dialysis Patients

“…There have been 4 reports examining the prognosis in patients with gastrointestinal malignancy, active tuberculosis, or end-stage liver disease (8, 10, 13, 14). There has been a report regarding the association with nutritional status alone and two reports regarding postoperative complications in patients with gastrointestinal malignancy or active tuberculosis (9, 11, 12).…”

Controlling Nutritional Status score does not predict patients' overall survival or hepatocellular carcinoma recurrence after deceased donor liver transplantation

“…The CONUT score is calculated on the basis of albumin levels, cholesterol levels, and total lymphocyte count in peripheral venous blood. It has been demonstrated that the CONUT score is a prognostic marker in surgically treated patients with colorectal cancer, esophageal squamous cell carcinoma, lung cancer, gastric cancer, hepatocellular carcinoma (HCC), and even end‐stage liver diseases (ESLD) . Nevertheless, data on the validity of the CONUT score in patients who underwent liver transplantation (LT) for HCC are currently lacking.…”

“…It has been demonstratedthattheCONUTscoreisaprognosticmarkerinsurgically treated patients with colorectal cancer, 3 esophageal squamous cellcarcinoma, 4 lungcancer, 5 gastriccancer, 6 hepatocellularcarcinoma (HCC), 1,2 and even end-stage liver diseases (ESLD). 7…”