Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Two-Stage Exchange Technique
2.3. Clinical Data Extraction and Nutritional Status Assessment
2.4. Clinical Outcome Assessment
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Prevalent Trends and Clinical Features of Malnutrition
3.3. Association between Malnutrition and Treatment Failure
3.4. Risk Factors for Moderate-to-Severe Malnutrition at 1st Stage Exchange
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Definition | 1st Stage Exchange | 2nd Stage Exchange | p |
---|---|---|---|
CONUT | 1.8 ± 1.7 | 1.3 ± 1.4 | <0.001 |
NPS | 2.1 ± 1.3 | 1.4 ± 1.1 | <0.001 |
NRI | 99.3 ± 6.1 | 102 ± 6.3 | <0.001 |
Appendix B
Definition | Failure Rate | OR (95% CI) | p | |
---|---|---|---|---|
Malnutrition at 1st Stage | ||||
CONUT | Normal | 28/95 (29.5%) | Reference Category | |
Mild | 18/73 (24.6%) | 0.72 (0.30−1.76) | 0.472 | |
Moderate-to-severe | 7/15 (46.7%) | 2.96 (0.75−11.67) | 0.102 | |
Malnutrition at 2nd Stage | ||||
CONUT | Normal | 20/111 (17.1%) | Reference Category | |
Mild | 14/49 (28.6%) | 3.02 (1.10−8.29) | 0.032 | |
Moderate-to-severe | 3/7 (42.9%) | 10.99 (1.38−87.54) | 0.024 |
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Characteristics | Value |
---|---|
Demographic Details | |
Age, years | 59.6 ± 13.2 |
Male gender | 87 (47.5) |
BMI, kg/m2 | 25.0 ± 4.1 |
Smoking | 11 (6.0) |
Comorbidities | |
Cardiovascular disease | 39 (21.3) |
Diabetes | 24 (13.1) |
Disease Data | |
Hip | 104 (56.8) |
Primary diagnosis | |
Osteoarthritis | 52 (28.4) |
ONFH | 44 (24.0) |
DDH | 3 (1.6) |
Inflammatory arthropathy | 11 (6.0) |
Fracture | 47 (25.7) |
Others | 26 (14.2) |
Pathogens | |
Staphylococcus aureus | 17 (9.3) |
Coagulase-negative Staphylococcus | 52 (28.4) |
Entoococcus | 3 (1.6) |
Streptococcus | 5 (2.7) |
Gram-Negative Bacteria | 9 (4.9) |
Others | 13 (7.1) |
Mixed | 30 (16.4) |
Negative | 50 (29.5) |
Number of prior procedures | 1.2 ± 1.1 |
Laboratory Test | |
Serum albumin, g/L | 38.5 ± 3.7 |
Lymphocyte count, 109/L | 1.8 ± 0.6 |
Total cholesterol, mmol/L | 165.9 ± 38.6 |
C-reactive protein, mg/dL | 2.4 ± 2.6 |
ESR, mm/h | 40.7 ± 26.8 |
Indicator | CRP | ESR | CONUT | NPS | NRI |
---|---|---|---|---|---|
CONUT | r = 0.34, p < 0.001 | r = 0.16, p = 0.029 | r = 0.63, p < 0.001 | r = −0.52, p < 0.001 | |
NPS | r = 0.34, p < 0.001 | r = 0.24, p = 0.001 | r = 0.63, p < 0.001 | r = −0.53, p < 0.001 | |
NRI | r = −0.29, p < 0.001 | r = −0.31, p < 0.001 | r = −0.52, p < 0.001 | r = −0.53, p < 0.001 |
MSIS Outcome | 1st Stage Exchange (n = 183) | 2nd Stage Exchange (n = 167) |
---|---|---|
Tier 1/2 | 130 (71.0) | 130 (77.8) |
Tier 3 | 31 (16.9) | 18 (10.8) |
Tier 3A | 4 (2.2) | 4 (2.4) |
Tier 3B | 2 (1.1) | 2 (1.2) |
Tier 3C | 3 (1.6) | 3 (1.8) |
Tier 3D | 6 (3.3) | 6 (3.6) |
Tier 3E | 3 (1.6) | 3 (1.8) |
Tier 3F | 13 (7.1) | - |
Tier 4 | 22 (12.0) | 19 (11.4) |
Tier 4A | 5 (2.7) | 2 (1.2) |
Tier 4B | 17 (9.3) | 17 (10.2) |
Definition | Failure Rate | OR * (95% CI) | p | |
---|---|---|---|---|
Malnutrition at 1st Stage | ||||
CONUT | Normal | 13/95 (13.7%) | Reference Category | |
Mild | 13/73 (17.8%) | 1.07 (0.38–3.01) | 0.891 | |
Moderate-to-severe | 6/15 (40.0%) | 5.86 (1.39–24.67) | 0.016 | |
NPS | Normal | 2/22 (9.1%) | Reference Category | |
Mild | 12/91 (13.2%) | 1.06 (0.18–6.14) | 0.945 | |
Moderate-to-severe | 18/70 (25.7%) | 2.32 (0.41–12.96) | 0.239 | |
NRI | Normal | 13/81 (16.0%) | Reference Category | |
Mild | 4/30 (13.3%) | 0.55 (0.13–2.30) | 0.415 | |
Moderate-to-severe | 15/72 (20.8%) | 0.86 (0.27–2.15) | 0.603 | |
Malnutrition at 2nd Stage | ||||
CONUT | Normal | 7/111 (6.3%) | Reference Category | |
Mild | 7/49 (14.3%) | 3.86 (1.03–14.44) | 0.045 | |
Moderate-to-severe | 2/7 (28.6%) | 12.15 (1.14–129.36) | 0.039 | |
NPS | Normal | 1/40 (2.5%) | Reference Category | |
Mild | 10/96 (10.4%) | 11.26 (0.92–138.22) | 0.068 | |
Moderate-to-severe | 5/31 (16.1%) | 14.39 (1.27–266.22) | 0.033 | |
NRI | Normal | 8/115 (7.0%) | Reference Category | |
Mild | 2/20 (10.0%) | 1.94 (0.28–13.41) | 0.501 | |
Moderate-to-severe | 6/32 (18.8%) | 3.60 (0.84–15.36) | 0.083 |
Variables | Odds Ratio | 95% CI | p |
---|---|---|---|
Age ≥ 68 | 5.35 | 1.17–24.52 | 0.031 |
Female gender | 0.31 | 0.07–1.26 | 0.101 |
Number of previous surgeries | 2.04 | 1.20–3.50 | 0.009 |
Primary diagnosis | |||
Osteoarthritis | Reference Category | ||
ONFH | 0.11 | 0.01–0.87 | 0.037 |
Inflammatory arthropathy | 7.16 | 0.51–101.45 | 0.146 |
Fracture | 0.17 | 0.02–1.29 | 0.087 |
Others | 1.41 | 0.20–9.86 | 0.729 |
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Li, Z.; Maimaiti, Z.; Li, Z.-Y.; Fu, J.; Hao, L.-B.; Xu, C.; Chen, J.-Y. Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection. Nutrients 2022, 14, 4433. https://doi.org/10.3390/nu14204433
Li Z, Maimaiti Z, Li Z-Y, Fu J, Hao L-B, Xu C, Chen J-Y. Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection. Nutrients. 2022; 14(20):4433. https://doi.org/10.3390/nu14204433
Chicago/Turabian StyleLi, Zhuo, Zulipikaer Maimaiti, Zhi-Yuan Li, Jun Fu, Li-Bo Hao, Chi Xu, and Ji-Ying Chen. 2022. "Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection" Nutrients 14, no. 20: 4433. https://doi.org/10.3390/nu14204433