Controlling Nutritional Status (CONUT) Score Is A Predictor Of Post-Operative Outcomes In Elderly Gastric Cancer Patients Undergoing Curative Gastrectomy: A Prospective Study

Figures & data

Table 1 Assessment Of Nutrition Status Based On CONUT Score

Parameter	Degree Of Malnutrition
Normal	Light	Moderate	Severe
Serum albumin (mg/dL)	> 35	30–34.9	25–29	< 25
Albumin score	0	2	4	6
Total Lymphocyte (/mL)	>1600	1200–1599	800–1199	< 800
Lymphocyte Score	0	1	2	3
Total Cholesterol (mg/dL)	> 180	140–180	100–139	< 100
Cholesterol Score	0	1	2	3
Total Score	0-1	2–4	5–8	9–12

Figure 1 Block flow chart of experimental grouping.

Table 2 Clinicopathological Features Of Patients According To Nutritional Status

Factors	Total	Normal (n= 153)	Light Malnutrition (n= 168)	Moderately Or Severe Malnutrition (n= 36)	P-Value
Age (years)	73.29 (5.24)	71.84 (4.77)	72.20 (4.77)	73.91 (5.79)	0.015*
Gender
Female	82	41	33	8	0.087
Male	275	112	135	28
BMI	21.61 (3.24)	21.76 (3.42)	22.16 (2.31)	20.93 (2.94)	<0.001*
Diabetes
No	311	136	144	31	0.241
Yes	46	17	24	5
ASA grade
I	24	13	10	1	0.199
II	245	109	113	23
III	86	31	43	12
IV	2	0	2	0
Preoperation	107.2 (21.07)	127.4 (16.42)	109.71 (19.9)	95.47 (22.73)	<0.001*
Hemoglobin (IQR)
TNM
I	119	64	49	6	0.013
II	87	33	44	10
III	151	56	75	20
Surgical method
Laparotomy	283	114	137	32	0.036
Laparoscopy	74	39	31	4
Type of anastomosis
Roux-en-Y	168	69	83	16	0.063
Billroth I	123	62	50	11
Billroth II	66	22	35	9
Type of gastrectomy
Subtotal	203	89	96	18	0.393
Total	154	64	72	18
Tumor location
Fundus	67	32	30	5	0.286
Body	76	30	40	6
Antrum	207	90	92	25
Pylorus	7	1	6	0
Surgery time (minutes)	202.6 (55.65)	203.2 (47.1)	203.86 (57.70)	196.81 (45.2)	0.903

Notes: The values given are number of patients unless indicated otherwise. * Statistically significant (P< 0.05).

Abbreviations: BMI, body mass index; TNM, Tumor Node Metastasis; ASA, American Society of Anaesthesiologists; IQR, interquartile range.

Table 3 The Relationship Between Postoperative Outcomes And Nutritional Status

Factors	Total	Normal	Light Malnutrition	Moderate Or Severe malnutrition	P–value
Postoperative complications
Clavien-Dindo Grade II	96	41	44	11	0.535
Delayed gastric emptying	9	2	5	2
Ileus	12	7	4	1
Pneumonia	22	1	17	4
Anastomosis leakage	2	1	1	0
Wound infection	4	2	2	0
Anastomosis stenosis	2	2	0	0
Ascites	7	4	2	1
Deep venous thrombosis	3	2	1	0
Small bowel obstruction	7	5	0	2
Lymph node Leakage	2	0	2	0
Pulmonary Embolism	2	1	1	0
Pleural effusion	39	5	30	4
Clavien-Dindo Grade III	24	11	13	0	0.460
Intra-abdominal bleeding	5	2	3	0
Intra-abdominal infection	19	9	10	0
Clavien-Dindo Grade IV	2	1	1	0	0.674
Septic shock	2	1	0	1
Clavien-Dindo Grade V	1	0	0	1	0.551
Multiple Organ Failure	1	0	0	1
Total complications	113	29	68	16	< 0.001
Lymph Node Metastasis	93	77	91	25	*0.132
Post-operative hospital stays (days)	18.15 (10.12)	15.69 (9.07)	18.70 (10.78)	17.92 (8.62)	0.290
30–days readmission	3	2	0	10	0.393
One Year survival
Alive	331	149	152	30	0.002*
Dead	26	4	16	6

Notes: Data are expressed as number of patients, * Statistically significant (P< 0.05).

Table 4 Univariate And Multivariate Analysis Of Factors Associated With Postoperative Complications

Factors	Univariate					Multivariate
Complications	No Complications	OR	95% CI	P-Value	OR	95% CI	P-Value
Age	74.45 (5.68)	71.75 (4.81)	1.105	1.057–1.155	0.022*	1.094	1.045.-1.145	< 0.001*
BMI	21.95 (3.45)	22.55 (3.13)	0.944	0.880–1.012	0.347
Hemoglobin	113.60 (21.5)	116.94 (21.88)	0.993	0.983–1.003	0.561
TNM
I	33	86
II	23	64	1.275	0.981–1.657	0.104
III	57	94
Surgical Method
Laparoscopy	24	50	1.070	0.618–1.852	0.809
Open	89	194
CONUT Score
Normal	29	124
Light Malnutrition	68	100	2.99	1.832–4.891	< 0.001*	2.695	1.631–4.451	< 0.001*
Moderate/Severe Malnutrition	16	20

Notes: *Statistically significant (P < 0.05), Data are expressed as number of patients.

Abbreviations: OR, Odds Ratio; CI, Confidence Interval; BMI, Body Mass Index, CONUT Score, Controlling Nutritional Status.

Table 5 Univariate And Multivariate Analysis Of Factors Associated With 1-Year Survival

Factors	Univariate					Multivariate
Alive	Dead	OR	95% CI	P-Value	OR	95% CI	P-Value
Age	72.18 (4.96)	78.00 (5.84)	1.225	1.130–1.328	< 0.001*	1.214	1.116.-1.321	< 0.001*
BMI	22.45 (3.21)	21.26 (3.52)	0.900	0.802–1.010	0.044*	0.967	0.845 −1.107	0.072
Hemoglobin	116.53 (21.76)	107.65 (18.53)	0.982	0.965–1.000	0.815
TNM
≤ II	196	10	2.232	1.023–5.274	0.039*	2.398	0.982–5.853	0.036*
> II	135	16
Surgical Method
Laparoscopy	74	12	0.297	0.069–1.289	0.087
Open	257	24
CONUT Score
Normal	149	4
Light Malnutrition	152	16	4.503	1.518–13.354	0.030*	2.909	0.909–9.311	0.021*
Moderate/Severe Malnutrition	30	6

Notes: *Statistically significant (P < 0.05), Data are expressed as number of patients.

Abbreviations: OR, Odds Ratio; CI, Confidence Interval; BMI, Body Mass Index, CONUT Score, Controlling Nutritional Status.