Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Impact of Controlling Nutritional Status score on short-term outcomes after carotid endarterectomy: a retrospective cohort study

  • Hee Won Son (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Gyeongseok Yu (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Seung Jun Lee (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jimi Oh (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Received : 2022.07.22
  • Accepted : 2022.09.19
  • Published : 2023.07.31
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Abstract

Background: Malnutrition and impaired immune responses significantly affect the clinical outcomes of patients with atherosclerotic stenosis. The Controlling Nutritional Status (CONUT) score has recently been utilized to evaluate perioperative immunonutritional status. This study aimed to evaluate the relationship between immunonutritional status, indexed by CONUT score, and postoperative complications in patients undergoing carotid endarterectomy (CEA). Methods: We retrospectively evaluated 188 patients who underwent elective CEA between January 2010 and December 2019. The preoperative CONUT score was calculated as the sum of the serum albumin concentration, total cholesterol level, and total lymphocyte count. The primary outcome was postoperative complications within 30 days after CEA, including major adverse cardiovascular events, pulmonary complications, stroke, renal failure, sepsis, wounds, and gastrointestinal complications. Cox proportional hazards regression analysis was used to estimate the factors associated with postoperative complications during the 30-day follow-up period. Results: Twenty-five patients (13.3%) had at least one major complication. The incidence of postoperative complications was identified more frequently in the high CONUT group (12 of 27, 44.4% vs. 13 of 161, 8.1%; p<0.001). Multivariate analyses showed that a high preoperative CONUT score was independently associated with 30-day postoperative complications (hazard ratio, 5.98; 95% confidence interval, 2.56-13.97; p<0.001). Conclusion: Our results showed that the CONUT score, a simple and readily available parameter using only objective laboratory values, is independently associated with early postoperative complications.

Keywords

References

  1. French BR, Boddepalli RS, Govindarajan R. Acute ischemic stroke: current status and future directions. Mo Med 2016;113:480-6. 
  2. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421-8.  https://doi.org/10.1001/jama.1995.03520420037035
  3. European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991;337:1235-43.  https://doi.org/10.1016/0140-6736(91)92916-P
  4. Timmerman N, Waissi F, Dekker M, van de Pol QY, van Bennekom J, Schoneveld A, et al. Pre-operative plasma extracellular vesicle proteins are associated with a high risk of long term secondary major cardiovascular events in patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg 2021;62:705-15.  https://doi.org/10.1016/j.ejvs.2021.06.039
  5. Jin H, Zhu K, Wang W. The predictive values of pretreatment controlling nutritional status (CONUT) score in estimating short- and long-term outcomes for patients with gastric cancer treated with neoadjuvant chemotherapy and curative gastrectomy. J Gastric Cancer 2021;21:155-68.  https://doi.org/10.5230/jgc.2021.21.e14
  6. Wang A, He Z, Cong P, Qu Y, Hu T, Cai Y, et al. Controlling nutritional status (CONUT) score as a new indicator of prognosis in patients with hilar cholangiocarcinoma is superior to NLR and PNI: a single-center retrospective study. Front Oncol 2021;10:593452. 
  7. Muller L, Hahn F, Mahringer-Kunz A, Stoehr F, Gairing SJ, Foerster F, et al. Immunonutritive scoring in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: Prognostic Nutritional Index or Controlling Nutritional Status score? Front Oncol 2021;11:696183. 
  8. Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Yamamoto E, et al. Association with controlling nutritional status (CONUT) score and in-hospital mortality and infection in acute heart failure. Sci Rep 2020;10:3320. 
  9. Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol 2015;32:88-105.  https://doi.org/10.1097/EJA.0000000000000118
  10. Poulia KA, Yannakoulia M, Karageorgou D, Gamaletsou M, Panagiotakos DB, Sipsas NV, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr 2012;31:378-85.  https://doi.org/10.1016/j.clnu.2011.11.017
  11. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999;15:116-22.  https://doi.org/10.1016/S0899-9007(98)00171-3
  12. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987;11:8-13.  https://doi.org/10.1177/014860718701100108
  13. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005;82:777-83.  https://doi.org/10.1093/ajcn/82.4.777
  14. Wang ZJ, Zhou YJ, Galper BZ, Gao F, Yeh RW, Mauri L. Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta-analysis. Heart 2015;101:1631-8.  https://doi.org/10.1136/heartjnl-2014-307119
  15. Cakmak EO, Ocal L, Erdogan E, Cersit S, Efe SC, Karagoz A, et al. Prognostic value of 3 nutritional screening tools to predict 30-day outcome in patients undergoing carotid artery stenting. Angiology 2022;73:225-33.  https://doi.org/10.1177/00033197211040365
  16. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 2005;20:38-45. 
  17. Takagi K, Domagala P, Polak WG, Buettner S, Ijzermans JN. The controlling nutritional status score and postoperative complication risk in gastrointestinal and hepatopancreatobiliary surgical oncology: a systematic review and meta-analysis. Ann Nutr Metab 2019;74:303-12.  https://doi.org/10.1159/000500233
  18. Raposeiras Roubin S, Abu Assi E, Cespon Fernandez M, Barreiro Pardal C, Lizancos Castro A, Parada JA, et al. Prevalence and prognostic significance of malnutrition in patients with acute coronary syndrome. J Am Coll Cardiol 2020;76:828-40.  https://doi.org/10.1016/j.jacc.2020.06.058
  19. Foley NC, Salter KL, Robertson J, Teasell RW, Woodbury MG. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke 2009;40:e66-74.  https://doi.org/10.1161/STROKEAHA.108.518910
  20. Steenhagen E. Preoperative nutritional optimization of esophageal cancer patients. J Thorac Dis 2019;11(Suppl 5):S645-53.  https://doi.org/10.21037/jtd.2018.11.33
  21. Schillinger M, Exner M, Mlekusch W, Amighi J, Sabeti S, Schlager O, et al. Serum albumin predicts cardiac adverse events in patients with advanced atherosclerosis: interrelation with traditional cardiovascular risk factors. Thromb Haemost 2004;91:610-8.  https://doi.org/10.1160/TH03-08-0504
  22. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-43.  https://doi.org/10.1016/j.jacc.2005.02.054
  23. Cereda E, Pusani C, Limonta D, Vanotti A. The association of Geriatric Nutritional Risk Index and total lymphocyte count with short-term nutrition-related complications in institutionalised elderly. J Am Coll Nutr 2008;27:406-13.  https://doi.org/10.1080/07315724.2008.10719718
  24. Gomes F, Emery PW, Weekes CE. Risk of malnutrition is an independent predictor of mortality, length of hospital stay, and hospitalization costs in stroke patients. J Stroke Cerebrovasc Dis 2016;25:799-806.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.017
  25. Bandayrel K, Wong S. Systematic literature review of randomized control trials assessing the effectiveness of nutrition interventions in community-dwelling older adults. J Nutr Educ Behav 2011;43:251-62.  https://doi.org/10.1016/j.jneb.2010.01.004
  26. Paraskevas KI, Mikhailidis DP, Veith FJ, Spence JD. Definition of best medical treatment in asymptomatic and symptomatic carotid artery stenosis. Angiology 2016;67:411-9. https://doi.org/10.1177/0003319715624526