CONUT Score Effectively Stratifies Risk for Postoperative Complications in Crohn Disease

Investigators assessed the Controlling Nutritional Status’ (CONUT’s) efficacy in predicting postoperative complications in patients with Crohn disease.

The Controlling Nutritional Status (CONUT) score better predicted postoperative complications in patients with Crohn disease (CD) who underwent surgery than albumin (ALB) and the prognostic nutritional index (PNI), according to data published in Scientific Reports.

The study enrolled 202 patients with CD who sought surgical resection at the Inflammatory Bowel Disease Center of Zhejiang University in China from June 2016 to June 2019. Patients were evaluated for their CONUT score, an index based on serum albumin concentration, total blood cholesterol concentration, and total peripheral lymphocyte count. Receiver operating characteristic curves were calculated to examine the cutoff value for predictors of postoperative complications (3.5).

Most of the patients were men (66.8%). Nearly 40% (36.1%) of patients required enteral nutrition, and 64.9% were undergoing their first operation. A total of 60 patients received a protective ostomy; all patients received an anastomosis after bowel resection.

Regarding CONUT score, 40.1% of patients were found to be in the “low CONUT group” (score, <3.5). The remaining were in the “high CONUT group” (score, >3.5; average overall CONUT score, 4.3±0.2).

Laparoscopic surgery was successful in 59.4% of patients; 19.8% were converted to laparotomy. The patients with low CONUT scores had a higher rate of laparoscopic surgery (74.1% vs 49.6%; P =.001).

Most patients (67.3%) recovered from surgery without complication. The 66 patients who experienced postoperative events had mild (20.3%) or major (16.8%) complications. The major complications included wound infection (10.4%), early postoperative bowel obstruction (6.4%), and gastrointestinal bleeding (5.9%).

Patients with low CONUT scores had fewer complications (17.3% vs 43.0%; P <.001) and shorter hospital stays (8.6±0.6 vs 11.1±0.5 days; P =.002) vs patients with high CONUT scores. Beyond CONUT score, body mass index (P =.011), preoperative ALB concentration (P =.021), and preoperative infliximab use (P =.017) were associated with an increased risk for complications.

“The areas under the curve for the CONUT score, ALB, and PNI were 0.611, 0.399, and 0.418, respectively, which indicated that the CONUT score might be a better predictor of postoperative complications,” the study authors stated. The CONUT score was also found to have a sensitivity of 78.8% and a specificity of 50.7%.

This study was limited by its retrospective observational nature and the remainder of some residual confounding factors, such as the selection bias that resulted from the study’s exclusive recruitment of patients with CD. The investigators added that the cutoff value “needs to be evaluated in other cohorts to verify the conclusion of the current study.” However, based on the study’s findings, “a preoperative CONUT score cutoff value of more than 3.5 could help to identify patients with a high possibility of malnutrition and postoperative complications,” they concluded.

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Dong X, Tang S, Liu W, et al. Prognostic significance of the Controlling Nutritional Status (CONUT) score in predicting postoperative complications in patients with Crohn’s disease. Sci Rep. 2020;10(1):19040. doi:10.1038/s41598-020-76115-0