Li Yafang, Nie Chuang, Li Na, Liang Jieying, Su Ning, Yang Chunhua
Department of Intensive Care Unit, Biomedical Innovation Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Hematopathology, Biomedical Innovation Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Nutr. 2025 Jan 13;11:1425956. doi: 10.3389/fnut.2024.1425956. eCollection 2024.
Postoperative pulmonary complications (PPCs) significantly impact surgical outcomes, and Controlling Nutritional Status (CONUT) score, a simple and easily available nutritional score, has been demonstrated to be significantly associated with postoperative patient outcomes and complications, including PPCs. However, there are few studies that specifically focus on patients undergoing radical surgery for colorectal cancer (CRC).
We retrospectively analyzed the clinical data of 2,553 patients who underwent radical surgery for CRC at the Sixth Affiliated Hospital of Sun Yat-sen University. Patients were divided into three groups: normal nutrition group (CONUT≤1), mild malnutrition group (2 ≤ CONUT≤4), and moderate-to-severe malnutrition group (CONUT≥5). Risk factors for PPCs and all-cause mortality were evaluated by multivariate regression. In addition, we assessed surgical outcomes including ICU admission, hospital stay, 1-year mortality and tumor-related mortality.
The incidence of PPCs was 9.0% ( = 230). Multiple regression showed that the higher the CONUT score, the higher the risk of PPCs (mild malnutrition group vs. normal nutrition group, OR: 1.61, 95% CI: 1.18-2.20, = 0.003; moderate-to-severe malnutrition group vs. normal nutrition group, OR: 2.41, 95% CI: 1.51-3.84, < 0.001). All-cause mortality was significantly higher in moderate-to-severe malnutrition group than that in normal nutrition group, HR: 1.88, (95% CI: 1.34-2.62, < 0.001). Older age, male sex, chronic heart disease, open surgery, blood transfusion during surgery, distant metastasis of tumor and colon tumor were all risk factors for PPCs. Furthermore, the malnutrition groups had poor surgical outcomes including postoperative pneumonia (mild vs. normal nutrition, OR: 1.64, 95% CI: 1.07-2.52, = 0.024; moderate-to-severe vs. normal nutrition, OR: 2.51, 95% CI: 1.36-4.62, = 0.00), ICU admission (mild vs. normal nutrition, OR: 2.16, 95% CI: 1.31-3.56, = 0.002; moderate-to-severe vs. normal nutrition, OR: 3.86, 95% CI: 2.07-7.20, < 0.001), hospital stay ≥14 days (mild vs. normal nutrition, OR: 1.30, 95% CI: 1.08-1.56, = 0.006) and 1-year mortality (mild vs. normal nutrition, HR: 1.65, 95% CI: 1.11-2.46, = 0.014; moderate-to-severe vs. normal nutrition, HR: 2.27, 95% CI: 1.28-4.02, = 0.005).
The preoperative CONUT score is a potential indicator for predicting PPCs and surgical outcomes in CRC patients.
术后肺部并发症（PPCs）显著影响手术结果，而控制营养状况（CONUT）评分作为一种简单且易于获取的营养评分，已被证明与术后患者的结局及并发症（包括PPCs）显著相关。然而，很少有研究专门针对接受结直肠癌（CRC）根治性手术的患者。
我们回顾性分析了中山大学附属第六医院2553例行CRC根治性手术患者的临床资料。患者被分为三组：营养正常组（CONUT≤1）、轻度营养不良组（2≤CONUT≤4）和中重度营养不良组（CONUT≥5）。通过多因素回归评估PPCs和全因死亡率的危险因素。此外，我们评估了手术结局，包括入住重症监护病房（ICU）、住院时间、1年死亡率和肿瘤相关死亡率。
PPCs的发生率为9.0%（n = 230）。多因素回归显示，CONUT评分越高，发生PPCs的风险越高（轻度营养不良组与营养正常组相比，OR：1.61，95%CI：1.18 - 2.20，P = 0.003；中重度营养不良组与营养正常组相比，OR：2.41，95%CI：1.51 - 3.84，P < 0.001）。中重度营养不良组的全因死亡率显著高于营养正常组，HR：1.88，（95%CI：1.34 - 2.62，P < 0.001）。年龄较大、男性、慢性心脏病、开放手术、手术期间输血、肿瘤远处转移和结肠肿瘤均为PPCs的危险因素。此外，营养不良组的手术结局较差，包括术后肺炎（轻度与营养正常组相比，OR：1.64，95%CI：1.07 - 2.52，P = 0.024；中重度与营养正常组相比，OR：2.51，95%CI：1.36 - 4.62，P = 0.00）、入住ICU（轻度与营养正常组相比，OR：2.16，95%CI：1.31 - 3.56，P = 0.002；中重度与营养正常组相比，OR：3.86，95%CI：2.07 - 7.20，P < 0.001）、住院时间≥14天（轻度与营养正常组相比，OR：1.30，95%CI：1.08 - 1.56，P = 0.006）和1年死亡率（轻度与营养正常组相比，HR：1.65，95%CI：1.11 - 2.46，P = 0.014；中重度与营养正常组相比，HR：2.27，95%CI：1.28 - 4.02，P = 0.005）。
术前CONUT评分是预测CRC患者PPCs和手术结局的一个潜在指标。
