Search Results (75)

Background/Objectives: Patients with stage IV gastric cancer who develop chronic intestinal failure require home parenteral nutrition (HPN). This study aimed to evaluate the prognostic relevance of nutritional and immune–inflammatory biomarkers and to construct an individualised survival prediction model using machine learning techniques. Methods: A secondary analysis was performed on a cohort of 410 patients with TNM stage IV gastric adenocarcinoma who initiated HPN between 2015 and 2023. Nutritional and inflammatory indices, including the Controlling Nutritional Status (CONUT) score and lymphocyte-to-monocyte ratio (LMR), were assessed. Independent prognostic factors were identified using Cox proportional hazards models. A Random Survival Forest (RSF) model was constructed to estimate survival probabilities and quantify variable importance. Results: Both the CONUT score and LMR were independently associated with overall survival. In multivariate analysis, higher CONUT scores were linked to increased mortality risk (HR = 1.656, 95% CI: 1.306–2.101, p < 0.001), whereas higher LMR values were protective (HR = 0.632, 95% CI: 0.514–0.777, p < 0.001). The RSF model demonstrated strong predictive accuracy (C-index: 0.985–0.986) and effectively stratified patients by survival risk. The CONUT score exerted the greatest prognostic influence, with the LMR providing additional discriminatory value. A gradual decline in survival probability was observed with an increasing CONUT score and a decreasing LMR. Conclusions: The application of machine learning to immune–nutritional data offers a robust tool for predicting survival in patients with advanced gastric cancer requiring HPN. This approach may enhance risk stratification, support individualised clinical decision-making regarding nutritional interventions, and inform treatment intensity adjustment. Full article

Background/objectives: Nutritional status is increasingly acknowledged as a pivotal determinant of clinical course and recovery in patients with acute ischemic stroke (AIS). Malnutrition can compromise immune competence, delay neurological recovery, and exacerbate adverse outcomes, particularly in those undergoing intensive interventions such as mechanical thrombectomy (MT). To objectively assess nutritional status, indices such as the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score have been utilized in various clinical populations. These indices incorporate routinely available laboratory parameters, reflecting both nutritional and inflammatory states. This study explores whether PNI and CONUT scores are associated with 90-day clinical outcomes in AIS patients treated with MT, aiming to evaluate their potential utility as prognostic biomarkers in acute stroke care. Methods: A total of 404 patients with AIS who underwent MT between 2023 and 2024 were retrospectively evaluated. Demographic, clinical, and laboratory data were collected, and nutritional status was assessed using PNI and CONUT scores. Clinical outcomes were stratified as favorable (modified Rankin Scale [mRS] 0–2) or unfavorable (mRS 3–6) at 90 days post-stroke. Results: Among the 404 patients included in the study, 50.5% had favorable and 49.5% had unfavorable clinical outcomes. Patients with favorable outcomes were younger (71 vs. 78 years, p = 0.001), had lower National Institutes of Health Stroke Scale (NIHSS) scores, and higher Alberta Stroke Program Early CT Scores (ASPECTS) (p = 0.001). The puncture-to-recanalization time was significantly longer in the unfavorable outcome group (47.5 min vs. 30.0 min, p = 0.003). Laboratory findings revealed higher glucose levels (p = 0.029), and lower serum albumin (p = 0.003) and lymphocyte levels (p = 0.001) in the unfavorable outcome group. Among nutritional indices, the CONUT score was significantly higher in the unfavorable outcome group (p = 0.001), whereas the PNI score was higher in the favorable outcome group (p = 0.001). ROC analysis showed that the CONUT score had significant prognostic performance (AUC = 0.721, p < 0.001), while the PNI had poor discriminatory power (AUC = 0.274, p < 0.001). Multivariate logistic regression identified age, baseline NIHSS, ASPECT score, and CONUT score as independent predictors of clinical outcome (p < 0.05). Conclusions: Among the two nutritional indices evaluated, the CONUT score demonstrated significant prognostic value in predicting 90-day clinical outcomes after MT. In contrast, the PNI showed limited discriminatory power, highlighting the superiority of CONUT as a reliable biomarker in acute stroke care. Full article

Background/Objectives: Loop diuretics are among the most commonly used drugs in patients with heart failure with reduced ejection fraction (HFrEF). Higher doses of these diuretics are associated with poorer clinical status and may contribute to malnutrition. The study aims to assess the relationship between the use of high-dose loop diuretics and nutritional status in patients with HFrEF. Methods: The study included 353 hospitalized patients with HFrEF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Geriatric Nutritional Index (GNRI), and the CONtrolling NUTritional status (CONUT). Patients were divided into three groups according to the daily dose of loop diuretics (defined as furosemide equivalent = 1 × furosemide dose and 2 × torsemide dose): low dose (LD), 40 mg/day or no treatment; medium dose (MD), 41–160 mg/day; or high dose (HD), >160 mg/day. Results: Of the evaluated patients, the mean MNA score was 23.31 ± 2.93 points, and 49.8% were at risk of malnutrition or malnourished. According to the MNA, patients in HD and MD groups had worse nutritional status than the LD group, similarly according to the GNRI. For CONUT, the differences were significant between all groups: nutritional status was the worst in the HD group, intermediate in the MD group, and the best in the LD group. Conclusions: The intake of loop diuretics, especially in high doses, correlates with an elevated risk of malnutrition in patients with HFrEF independently of sex, age, NYHA class, and left ventricular ejection fraction. Full article

Background: Assessing nutrition-related health risks in older individuals is often overlooked in clinical practice due to the lack of appropriate methods of evaluation. While anthropometric measurements and body composition analyses are mainly used, these tools are not standardized for the oldest old and fail to account for age-related changes. This underscores the need for improved assessment techniques that accurately capture the progressive and non-linear shifts in nutritional status throughout the aging process. Accordingly, the primary aim of our paper is to identify the most effective tools to use for evaluating nutritional status in the oldest population. Methods: To address this gap, we conducted a cross-sectional study, investigating the nutritional status of a cohort of Sicilian individuals aged between 65 and 111, using methods commonly applied to adult and older adult populations. These included the BIoimpedance Analysis (BIA), the Mini Nutritional Assessment (MNA) evaluation, and nutritional risk indices such as the COntrolling NUTritional Status (CONUT) score and Geriatric Nutritional Risk Index (GNRI). Results: Despite the oldest population being classified as “at risk” of malnutrition by the MNA or “cachetic” by BIA, our results indicated a “normal” or “low risk” of malnutrition when assessments were performed using tools (GNRI and CONUT) that were not reliant on body composition parameters. These findings align with clinical history assessments conducted during their recruitment. Conclusions: This pilot study highlights the need for future research aimed at developing standardized, multidimensional assessment models tailored to the heterogeneity of each age group, to improve risk stratification, clinical outcomes, and personalized nutritional care. Full article

Heart failure (HF) is a major global health burden and a leading cause of morbidity and mortality. Nutritional status has emerged as an essential factor influencing outcomes in HF, with the Controlling Nutritional Status (CONUT) score gaining attention as a simple, objective marker derived from serum albumin, total cholesterol, and lymphocyte count. This meta-analysis evaluated the prognostic value of the CONUT score in predicting all-cause mortality in patients with acute and chronic heart failure. A systematic search was conducted in the PubMed, MEDLINE, Google Scholar, and Cochrane Library databases for the past ten years, using combinations of keywords such as “heart failure”, “CONUT score”, “malnutrition”, and “mortality”. Studies were included if they reported hazard ratios (HRs) for all-cause mortality in relation to CONUT score categories in adult HF populations. Eight eligible studies comprising 15,761 patients were included. Pooled analysis showed that higher CONUT scores were significantly associated with increased all-cause mortality (pooled HR = 1.47; 95% CI: 1.30–1.66). Despite substantial heterogeneity (I² = 80%), the direction of effect was consistent across studies. The CONUT score is a useful prognostic marker in acute and chronic heart failure patients. Further research should explore the effects of targeted nutritional interventions in high-risk HF patients identified by elevated CONUT scores and efforts to standardize malnutrition cut-offs in clinical practice. Full article

Background/Objectives: Reports on oral frailty as a risk factor for chronic constipation are scarce. In this study, we examined the relationship between Oral Frailty Index-8 (OFI-8) and constipation severity. Methods: This cross-sectional analysis involved patients aged ≥65 years (outpatients between November 2020 and November 2021). Patient background (age, sex, body mass index, medical history, lifestyle history, and oral medications), a constipation severity questionnaire (Constipation Scoring System [CSS]), grip strength, walking speed, skeletal muscle mass index (dual-energy X-ray absorptiometry), a frailty questionnaire, an oral frailty questionnaire (OFI-8), an abdominal symptoms quality of life (QOL) questionnaire (Izumo scale), a swallowing evaluation questionnaire (10-item Eating Assessment Tool [EAT-10]), a chronic obstructive pulmonary disease (COPD) evaluation questionnaire (COPD assessment test [CAT]), a simplified QOL evaluation (EuroQol-five dimensions [EQ-5D]), the Dietary Variety Score, a nutritional evaluation (CONtrolling NUTritional Status [CONUT] score), and the 15-item Geriatric Depression Scale (GDS-15) were analyzed. Risk factors for constipation severity (CSS) were examined using multivariate analysis. Patients with advanced gastrointestinal cancer, inflammatory bowel disease, and active gastroduodenal ulcer were excluded. Results: In total, 1029 patients (male/female: 450/579; mean age: 78.3 ± 6.1 years; mean body mass index: 22.9 ± 3) were included. Multivariate analysis demonstrated a significant association between CSS and OFI-8 (β = 0.065), EAT-10 (β = 0.061), sarcopenia (β = 0.050), laxative (β = 0.126), constipation-related QOL score (β = 0.625), diarrhea-related QOL score (β = −0.064), and CAT (β = 0.061). Conclusions: Comprehensive risk factors associated with CSS included a high oral frailty score, impaired swallowing (EAT-10), sarcopenia, laxative use, a high constipation QOL score, a low diarrhea QOL score, and COPD assessment through CAT. Full article

Background: Patients undergoing cardiovascular surgery often experience postoperative complications and Activities of Daily Living (ADL) decline, even in the absence of preoperative malnutrition. Since postoperative ADL decline is particularly serious in elderly patients, this study aimed to identify a nutritional assessment tool that is effective in predicting postoperative ADL decline. Methods: Patients undergoing open-heart surgery with cardiopulmonary bypass were assessed using eight nutritional assessment tools, including the Malnutrition Universal Screening Tool (MUST), the Global Leadership Initiative on Malnutrition (GLIM) criteria, the Nutritional Risk Screening 2002 (NRS-2002), the Subjective Global Assessment (SGA), the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and the Mini Nutritional Assessment-Short Form (MNA-SF). Results: A total of 197 patients were enrolled in this study, with a mean age of 70.4 ± 11.6 years old; 31.0% were female. Depending on the nutritional assessment tool, 17.8% to 78.2% of patients were identified as at risk of malnutrition. Among the various assessment tools, the MUST was the most effective in predicting postoperative ADL decline (OR 4.75, 95% CI 1.37–16.5, p = 0.014) and was also associated with severe complications and length of hospital stay (OR 3.08, 95% CI 0.20–0.76, p = 0.009). On the other hand, nutritional risk detected by assessment tools other than MUST, including MNA-SF and GLIM, could predict postoperative complications but showed no relationship to ADL decline. Conclusions: We concluded that MUST was the most useful preoperative nutritional assessment tool for predicting outcomes, particularly for assessing the risk of postoperative ADL decline in patients undergoing cardiovascular surgery. Full article

Objective: To investigate the predictive value of nutritional status in heart failure (HF) patients with an implantable cardioverter defibrillator (ICD), and to identify factors associated with ICD discharge and mortality. Methods: This retrospective study was conducted by analyzing data from 2017 to 2021. HF patients who underwent ICD implantation for primary prevention were included. Follow-up visits were continued until December 2022. Patients were examined based on ICD shock occurrence (ICD-A: appropriate shock), ICD non-discharge (ICD-X), and mortality. Nutritional status was assessed by the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) scores. Results: A total of 221 patients were included in the study, 86 of whom were in the ICD-A group (135 in the ICD-X group). Age and sex distribution were similar in these groups. The all-cause mortality rate was 20.36%. A PNI with a cut-off value of <47.25 and a CONUT score with a cut-off value of >2.5 were able to significantly predict all-cause mortality. The PNI had a greater area under the curve compared to the CONUT. Non-ischemic cardiomyopathy and high left-ventricle end-systolic diameter (ESD) were independently associated with appropriate ICD shock. Low systolic blood pressure, high ESD, low sodium, low total cholesterol, low (<47.25) PNI, and ICD shock were independently associated with all-cause mortality. Conclusions: Malnutrition appears to be associated with mortality in patients with primary-prevention ICDs, and the PNI appears to be a more useful indicator than the CONUT for determining the risk of mortality in these patients. Full article

Nutritional status is an important prognostic factor in patients with multiple myeloma (MM). The Controlling Nutritional Status (CONUT) score has shown promise in predicting outcomes in various malignancies; however, its role in autologous stem cell transplantation (ASCT) in patients with MM remains unclear. This study aimed to evaluate the significance of pre-transplant CONUT scores in predicting post-transplant engraftment kinetics and early complications in patients with MM undergoing ASCT. This single-center, retrospective study analyzed 59 multiple myeloma patients who underwent ASCT between 1 October 2022, and 1 July 2024. Pre-transplant CONUT scores were calculated, and their associations with various post-transplant outcomes were assessed using statistical analyses. Higher CONUT scores were independently associated with longer neutrophil engraftment times (p = 0.012). Patients who developed oral mucositis (OM) had significantly higher CONUT scores than those without OM (p = 0.028). A CONUT score cut-off of 2.5 demonstrated 100% sensitivity and 57.14% specificity in predicting OM (Area Under the Curve (AUC) 0.792, 95% CI: 0.654–0.930, p = 0.033). Our study demonstrates that a higher pre-transplant CONUT score is significantly associated with a delay in neutrophil engraftment and an increased risk of developing oral mucositis. These findings suggest that the CONUT score can serve as a valuable predictive tool for early post-transplant complications, thereby guiding targeted interventions and improving patient management. Full article

Background: Pancreatic cancer is a highly aggressive malignancy with a poor prognosis. Neoadjuvant chemotherapy (NAC) is increasingly used to improve survival in patients with pancreatic cancer; however, it often results in nutritional deterioration, which may negatively impact patient outcomes. Therefore, this study aimed to assess the effect of changes in nutritional status on the long-term outcomes of patients with pancreatic cancer who underwent curative surgery after NAC. Methods: This retrospective single-center study included 148 patients with pancreatic cancer who underwent curative surgery after NAC between 2010 and 2020. The Controlled Nutritional Status (CONUT) score was used to determine the nutritional status of the patients. Patients were categorized into worsened, maintained, and improved groups based on the changes in their CONUT scores before and after NAC. We compared differences in overall survival (OS) and disease-free survival (DFS) between the groups. Results: The worsened nutritional status group exhibited the shortest median OS (28 months) compared to the maintained and improved groups (39 and 66 months, respectively; p = 0.01). Additionally, the worsened group demonstrated the shortest DFS compared to the other two groups (13, 22, and 39 months, respectively; p = 0.02). Multivariate analysis identified nutritional deterioration as an independent prognostic factor for OS (hazard ratios (HR), 2.11; 95% confidence intervals (CI), 1.31–3.40; p < 0.01). Conclusions: Nutritional deterioration after NAC is a significant prognostic factor of poor survival outcomes in patients with pancreatic cancer. These findings indicate that serial nutritional assessments and treatment during NAC are crucial for improving patient outcomes. Full article

Background: Sepsis is a critical condition characterized by severe immune dysregulation, ranking among the leading causes of morbidity and mortality in intensive care and internal medicine units. Nutritional status plays a pivotal role in modulating these responses, as when inadequate it can compromise immune defenses, the body’s ability to handle stress and inflammation, and the clinical course. Malnutrition is frequently observed in septic patients and is strongly associated with worse clinical outcomes, including increased mortality, prolonged hospital stays, and greater complication rates. In this context, nutritional scoring systems have emerged as valuable tools to evaluate patients’ nutritional status and predict clinical trajectories. Objectives: Given the absence of a direct comparison of their performance in an internal medicine setting, this study aimed to assess the effectiveness of various nutritional scores as predictive tools for clinical outcomes in septic patients, emphasizing their application within the field of internal medicine. Methods and Results: A retrospective analysis was conducted on 143 patients diagnosed with sepsis or septic shock who were admitted to an internal medicine unit. Key variables included clinical and laboratory parameters, comorbidities, and nutritional scores at the time of diagnosis. The modified Glasgow Prognostic Score (mGPS), the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, the modified Nutrition Risk in Critically Ill (mNUTRIC) score, and the blood urea nitrogen-to-albumin ratio (BAR) were evaluated in forecasting mortality and clinical outcomes in patients with sepsis. Among them, the mNUTRIC score emerged as the strongest independent predictor of in-hospital mortality, with a good performance and a reasonable threshold for risk stratification. Conclusions: The study highlights the mNUTRIC score’s practicality and reliability in assessing nutritional and inflammatory risks in septic patients, particularly in non-ICU settings. These findings suggest its potential utility in guiding nutritional interventions and improving clinical outcomes, emphasizing the importance of integrating nutritional assessment into sepsis management. Full article

Background: Malnutrition affects patients undergoing surgery for gastrointestinal cancers and contributes to poor postoperative outcomes, including increased complication rates, longer hospital stays, and higher mortality. Despite the availability of several malnutrition screening tools and prognostic scores, their effectiveness in predicting postoperative outcomes remains unclear. This study aimed to compare the predictive accuracy of Patient-Generated Subjective Global Assessment (PG-SGA), Global Leadership Initiative on Malnutrition (GLIM), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score for postoperative outcomes in patients undergoing surgery for colorectal, hepato-pancreato-biliary and upper gastrointestinal cancers. Methods: A cross-sectional observational study from March 2022 to October 2023 was conducted in two university surgical departments, after registration on ClinicalTrials database (NCT05795374). Patient characteristics, preoperative nutritional status and postoperative outcomes were analyzed. Results: In total, 480 patients were enrolled. CONUT and GNRI demonstrated high specificity (over 90% and 80%, respectively) for predicting overall complications, major complications, prolonged hospital stay, mortality, and advanced disease stage across all cancer types. Notably, CONUT showed a specificity over 97% and GNRI over 89.7% for colorectal and upper gastrointestinal cancer patients, respectively, despite their lower sensitivity. On the contrary, PG-SGA and GLIM presented better sensitivity (up to 50%), but slightly lower specificity (up to 86.4%). Conclusions: CONUT and GNRI are valuable for ruling out non-at-risk patients for adverse postoperative outcomes, while PG-SGA and GLIM provide better sensitivity. A step-up approach—initial screening with PG-SGA and GLIM, followed by detailed evaluation with CONUT or GNRI— should be validated in future studies across diverse clinical settings. Full article

The management of chronic intestinal failure (CIF) secondary to advanced gastric cancer poses clinical challenges. This study explores the correlation between the Controlling Nutritional Status (CONUT) index and survival in patients with TNM stage IV gastric cancer on home parenteral nutrition (HPN). Methods: From 2015 to 2023, 410 patients (37% women, 63% men) with CIF due to advanced gastric cancer were assessed using CONUT scores, BMI, and biochemical tests. The Cox proportional hazards model was used to evaluate the impact of covariates on survival. Logistic regression categorized malnutrition levels by CONUT scores, with performance evaluated using precision, recall, and F1 scores. A p-value < 0.001 was statistically significant. Results: The CONUT scores were independent predictors of survival, with higher CONUT scores increasing mortality risk (HR = 2.073, 95% CI: 1.815–2.369, p < 0.001). The model achieved an overall accuracy of 71%, indicating correct classification for the majority of cases. Conclusions: CONUT scores are key predictors of survival in patients receiving HPN for CIF due to stage IV gastric cancer. Full article

Background: Nutritional status is an important factor influencing toxicity of treatment. Nutritional assessment indicators such as the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score and modified Glasgow Prognostic Score (mGPS) have been reported to be associated with treatment-related adverse events (AEs) for various malignancies. However, there are no reports investigating the relationship between nutritional status and AEs from poly-(ADP-ribose) polymerase (PARP) inhibitors (PARPi), which are widely used in recent years as maintenance therapy for ovarian cancer. Objective: The primary objective was to investigate the usefulness of nutritional assessment indicators in predicting treatment discontinuation due to AEs from PARPi. Methods: This multicenter retrospective study included patients diagnosed with ovarian cancer who received maintenance therapy with PARPi from January 2018 to December 2023. PNI, CONUT score, and mGPS were calculated based on hematological parameters measured within 7 days before the start of PARPi therapy. Results: A total of 272 patients received maintenance therapy with PARPi during the period, but due to the absence of the blood collection of albumin levels within one week or other exclusion criteria, 71 patients were finally included in this analysis. AEs were seen in 59 patients (83.1%), including 25 (35.2%) severe events (grade ≥3 in Common Terminology Criteria for Adverse Events v5.0). Eighteen patients (25.4%) discontinued treatment due to PARPi-related AEs. Low PNI (<48.44) and high mGPS (≥1) were predictors of treatment discontinuation in both univariate and multivariate analyses. CONUT was not a significant predictor in this study. Conclusions: Our study suggested that PNI and mGPS can predict the risk of treatment discontinuation due to PARPi-related AEs before starting maintenance therapy. This insight opens avenues for more personalized treatment plans, potentially improving patient outcomes. Full article

Background and Objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher’s exact test for categorical variables and a Mann–Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs). Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59–0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (>2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17–3.09; p 0.05), stage II–III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79–28.3; p 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58–10.4; p 0.004). Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN. Full article