The prognostic impact of the controlling nutritional status (CONUT) score in patients undergoing cardiovascular surgery

Procalcitonin as a biomarker for postoperative pneumonia: a study on dynamics following cardiopulmonary bypass in adults

OBJECTIVE

Postoperative pneumonia (POP) frequently complicates cardiac surgery that involves cardiopulmonary bypass (CPB). This study aimed to assess the diagnostic utility of procalcitonin (PCT) for identifying pneumonia after CPB-assisted cardiac surgery.

METHODS

Patients diagnosed with POP were enrolled in the retrospective matched case-control study and were admitted to a Grade III general hospital in Nanjing in 2023. POP diagnosis was determined based on a combination of clinical and microbiological criteria.PCT and white blood cell count (WBC) data were systematically collected from day 1 (T1) to day 5 (T5). Receiver operating characteristic (ROC) curve analysis and subject operating characteristics were utilized to evaluate the diagnostic performance of biomarkers. At the same time, a binary logistic regression model was developed to identify factors that influence the diagnosis of POP.

RESULTS

The study included 220 age- and sex-matched patients, comprising 56 individuals with POP and 164 uninfected patients constituting the non-POP group. ROC curve analysis revealed that serum PCT concentration exhibited an AUC > 0.7 from day 2 to day 5, whereas other indices demonstrated AUCs < 0.7 at these time points. Univariate and multivariate analyses highlighted serum PCT concentration on day 2, WBC count on day 5, the PCTT4-T1 variation rate, and days of mechanical ventilation as significant predictive factors for POP diagnosis, each demonstrating statistical significance (P < 0.05). The calculated AUC was 0.837 (95%CI: 0.773-0.902). The absolute PCT value exhibited superior diagnostic performance relative to its variance rate and WBC count, yielding optimal diagnostic accuracy with a cutoff value of 3.45 ng/ml.

CONCLUSION

Serum PCT absolute value demonstrates higher sensitivity and specificity than other indices, offering superior diagnostic potential for predicting POP.

Impact of Controlling Nutritional Status Score on Mortality in Elderly Patients with Idiopathic Pulmonary Fibrosis

Background: There are only a few reports on the nutritional status and mortality of patients with idiopathic pulmonary fibrosis (IPF). As such, this study aims to investigate the relationship between controlling nutritional status (CONUT) and the mortality of elderly patients with IPF. Methods: A total of 170 IPF patients aged ≥65 years old who visited the rehabilitation department of our hospital between July 2014 and July 2021 (mean age: 75.7 ± 6.3 years, sex (male/female): 138/32, %FVC: 78.3 ± 18.3%) were retrospectively analyzed. The Kaplan-Meier method and log-rank test were applied. Furthermore, using a Cox proportional hazards model with multivariate analysis, we analyzed the relationship between all-cause mortality and baseline characteristics including CONUT. Results: Based on the CONUT score, the normal group included 101 cases, the mild group included 58 cases, the moderate group included 11 cases, and the severe group had 0 cases. There were 49 cases of all-cause mortality events, suggesting that the mortality of the moderate group was significantly poorer than that of the normal and mild groups (p < 0.05). Furthermore, multivariate analysis identified GAP stage (HR: 5.972, 95%CI: 2.901~12.291, p < 0.0001), mMRC scale (HR: 0.615, 95%CI: 0.389~0.971, p = 0.009), and CONUT (HR: 2.012, 95%CI: 1.192~3.395, p = 0.037) as factors significantly influencing mortality. Conclusions: Severe malnutrition was not observed in elderly patients with IPF. Moderate malnutrition was associated with a significantly higher risk of all-cause mortality, suggesting that CONUT is an important indicator for predicting mortality.

Predictive Role of Preoperative Nutritional Status on Early Postoperative Outcomes in Different-Aged Patients Undergoing Heart Valve Surgery

OBJECTIVES

The authors sought to elucidate the role and predictive effects of preoperative nutritional status on postoperative outcomes across different age groups undergoing heart valve surgery.

DESIGN

A retrospective study with intergroup comparison, receiver operating characteristic curve analysis, and logistic regression analysis.

SETTING

A hospital affiliated with a medical university.

PARTICIPANTS

Three thousand nine hundred five patients undergoing heart valve surgery between October 2016 and December 2020.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patients were categorized into 3 age subgroups: young (aged 18-44 years), middle-aged (aged 45-59 years), and older (aged ≥60 years) adults. The Nutritional Risk Index (NRI), Prognostic Nutritional Index, and Controlling Nutritional Status scores were evaluated. Young adults with an NRI <99 experienced a significantly higher rate of prolonged intensive care unit stay (28.3% v 4.1%, p < 0.001), with a relative risk of 4.58 (95% CI: 2.04-10.27). Similarly, young adults with an NRI <97 had a significantly increased occurrence of mortality within 30 days after surgery (6.3% v 0.2%, p < 0.001), with a relative risk of 41.11 (95% CI: 3.19-529.48).

CONCLUSIONS

In patients who undergo heart valve surgery, early postoperative outcomes can be influenced by nutritional status before the surgery. In the young-adult group, NRI <99 and NRI <97 effectively could predict prolonged intensive care unit stay and 30-day mortality, respectively.