Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.
Sci Rep. 2020 Nov 4;10(1):19040. doi: 10.1038/s41598-020-76115-0.
Preoperative immune-nutritional status is correlated with postoperative outcomes. The Controlling Nutritional Status (CONUT) score is a useful tool for predicting the postoperative outcomes of cancer surgery. This study aimed to evaluate whether the CONUT score could predict postoperative complications in Crohn's disease (CD) patients. In total, 202 CD patients were eligible. Univariate and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic (ROC) curves were generated to examine the cutoff value for predictors of postoperative complications. Among all the patients, 66 developed postoperative complications. The cut-off value of the CONUT score was 3.5 for complications. Eighty-one patients had a low CONUT score (< 3.5), and 121 patients had a high CONUT score (> 3.5). There was a significant difference in postoperative complications between the groups with low and high CONUT score (17.3% vs. 43.0%, p < 0.001). Patients with high CONUT score had low body mass index (BMI), more mild postoperative complications (p = 0.001) and a longer postoperative stay (p = 0.002). Postoperative complications were correlated with BMI, preoperative albumin, the preoperative CONUT score, and preoperative infliximab use. Then, the preoperative CONUT score was an independent risk factor for complications (OR 3.507, 95% CI 1.522-8.079, p = 0.003). ROC analysis showed that the CONUT score was a better predictor of postoperative complications in CD patients than albumin and the prognostic nutritional index. Thus, a preoperative CONUT score cut-off value of more than 3.5 could help to identify patients with a high possibility of malnutrition and postoperative complications.
术前免疫营养状况与术后结果相关。控制营养状况（CONUT）评分是预测癌症手术术后结果的有用工具。本研究旨在评估 CONUT 评分是否可预测克罗恩病（CD）患者的术后并发症。共有 202 例 CD 患者符合条件。进行单因素和多因素分析以确定术后并发症的危险因素。生成受试者工作特征（ROC）曲线以检查预测术后并发症的截断值。在所有患者中，有 66 例发生术后并发症。CONUT 评分的截断值为 3.5 分用于并发症。81 例患者 CONUT 评分较低（<3.5），121 例患者 CONUT 评分较高（>3.5）。低 CONUT 评分组和高 CONUT 评分组之间术后并发症发生率存在显著差异（17.3%比 43.0%，p<0.001）。高 CONUT 评分患者的 BMI 较低，术后并发症较轻（p=0.001），术后住院时间较长（p=0.002）。术后并发症与 BMI、术前白蛋白、术前 CONUT 评分和术前英夫利昔单抗使用有关。然后，术前 CONUT 评分是并发症的独立危险因素（OR 3.507，95%CI 1.522-8.079，p=0.003）。ROC 分析表明，CONUT 评分在 CD 患者中对术后并发症的预测优于白蛋白和预后营养指数。因此，术前 CONUT 评分>3.5 可帮助识别有发生营养不良和术后并发症高可能性的患者。
