Acute Crit Care.  2024 Feb;39(1):127-137. 10.4266/acc.2023.01613.

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea

• Baek MS
• Kwon YS
• Kang SS
• Shim D
• Yoon Y
• Kim JH

• KMID: 2555231
• DOI: http://doi.org/10.4266/acc.2023.01613

Abstract

Background
The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis. Methods: Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models. Results: The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12; P<0.001). Conclusions: The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

Keyword

malnutrition; mechanical ventilation; mortality; nutritional status; sepsis

Figure

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  Figure 1. Flowchart of the enrollment process. ICU: intensive care unit; ER: emergency room; SOFA: Sequential Organ Failure Assessment; WBC: white blood cell.

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  Figure 2. Survival curve of nutrition indices for sepsis mortality. (A) Controlling Nutrition Status (CONUT) scores in all sepsis patients. (B) Prognostic nutritional index (PNI) scores in all sepsis patients. (C) CONUT scores in mechanically ventilated (MV) sepsis patients. (D) PNI scores in MV sepsis patients. ICU: intensive care unit.

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  Figure 3. Forest plot of hazard ratios for 30-day mortality based on multivariate analysis with clinical variables. (A) Controlling Nutrition Status (CONUT) scores. (B) Prognostic nutritional index (PNI) scores. HR: hazard ratio; CI: confidence interval; SOFA: Sequential Organ Failure Assessment; APACHE: Acute Physiology And Chronic Health Evaluation.

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