The predictive value The predictive value of the CONUT score combined with the A2DS2 scale for post-ischemic stroke infection

  • Yongqing Zhang Sichuan University, West China Hospital, Department of Emergency Medicine, Emergency Medical Laboratory, Chengdu, Sichuan, China
  • Wei Zhang Sichuan University, West China Hospital, Department of Emergency Medicine, Emergency Medical Laboratory, Chengdu, Sichuan, China
  • Yiwu Zhou Sichuan University, West China Hospital, Department of Emergency Medicine, Emergency Medical Laboratory, Chengdu, Sichuan, China
Keywords: age factors;, infections;, nutritional status;, prognosis;, risk factors;, stroke

Abstract


Background/Aim. Stroke-associated infection is the most common and most serious complication of ischemic stroke (IS), which is the most important cause of death and disability in humans. The aim of the study was to determine the predictive value of nutrition risk score – Controlling Nutritional Status (CONUT) combined with Age, Atrial Fibrillation, Dysphagia, Sex, Stroke Severity (A2DS2) scale for post-IS infection (PISI) in IS patients. Methods. This retrospective study analyzed the clinical data of 333 IS patients admitted to the Emergency Department of West China Hospital of Sichuan University from December 2017 to April 2019. Patients were divided into the No-PISI group (244 cases) and the PISI group (89 cases) based on whether they had a PISI. Multivariate logistic regression analysis was used to identify independent risk factors for PISI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the accuracy of different variables in predicting the outcome. Results. Multivariable logistic regression analysis showed that the CONUT score [odds ratio (OR) = 1.321, 95% confidence interval (CI): 1.040–1.677, p < 0.05] and age (OR = 1.026, 95%CI: 1.004–1.048, p < 0.05) were independent influencing factors for PISI. With the increase of the CONUT score, the proportion of PISI increased. Area under the ROC curve for predicting PISI was 0.651, 0.696, and 0.725 for CONUT, A2DS2, and CONUT plus A2DS2, respectively. Conclusion. Combining the CONUT score and A2DS2 scale enhances their predictability of PISI, thereby serving as a valuable tool for early risk assessment and clinical intervention.

References

GBD 2017 Mortality Collaborators. Global, regional, and na-tional age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1684–735. Erratum in: Lancet 2019; 393(10190): e44.

Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Preva-lence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation 2017; 135(8): 759–71.

Bustamante A, Vilar-Bergua A, Guettier S, Sánchez-Poblet J, Gar-cía-Berrocoso T, Giralt D, et al. C-reactive protein in the detec-tion of post-stroke infections: systematic review and individu-al participant data analysis. J Neurochem 2017; 141(2): 305–14.

Sunnerhagen KS, Opheim A, Alt Murphy M. Onset, time course and prediction of spasticity after stroke or traumatic brain in-jury. Ann Phys Rehabil Med 2019; 62(6): 431–4.

Westendorp WF, Nederkoorn PJ, Vermeij JD, Dijkgraaf MG, van de Beek D. Post-stroke infection: a systematic review and me-ta-analysis. BMC Neurol 2011; 11: 110.

Ni J, Shou W, Wu X, Sun J. Prediction of stroke-associated pneumonia by the A2DS2, AIS-APS, and ISAN scores: a sys-tematic review and meta-analysis. Expert Rev Respir Med 2021; 15(11): 1461–72.

Zapata-Arriaza E, Moniche F, Blanca PG, Bustamante A, Escude-ro-Martínez I, Uclés O, et al. External Validation of the ISAN, A2DS2, and AIS-APS Scores for Predicting Stroke-Associated Pneumonia. J Stroke Cerebrovasc Dis 2018; 27(3): 673–6.

Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, Gonzá-lez P, González B, Mancha A, et al. CONUT: a tool for control-ling nutritional status. First validation in a hospital popula-tion. Nutr Hosp 2005; 20(1): 38–45.

Wang PY, Chen XK, Liu Q, Xu L, Zhang RX, Liu XB, et al. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol 2021; 147(10): 3099–111.

Li W, Li M, Wang T, Ma G, Deng Y, Pu D, et al. Controlling Nutritional Status (CONUT) score is a prognostic factor in patients with resected breast cancer. Sci Rep 2020; 10(1): 6633.

Yılmaz A, Tekin SB, Bilici M, Yılmaz H. The Significance of Controlling Nutritional Status (CONUT) Score as a Novel Prognostic Parameter in Small Cell Lung Cancer. Lung 2020; 198(4): 695–704.

Peng B, Wu B. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018. Chin J Neurol 2018; 51(9): 666–82.

Hoffmann S, Malzahn U, Harms H, Koennecke HC, Berger K, Kalic M, et al. Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke. Stroke 2012; 43(10): 2617–23.

Worthmann H, Tryc AB, Dirks M, Schuppner R, Brand K, Klawonn F, et al. Lipopolysaccharide binding protein, interleukin-10, interleukin-6 and C-reactive protein blood levels in acute is-chemic stroke patients with post-stroke infection. J Neuroin-flammation 2015; 12: 13.

Hannawi Y, Hannawi B, Rao CP, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cere-brovasc Dis 2013; 35(5): 430–43.

Fang F, Shu Y, Xiao Z. Clinical research progress in stroke-associated pneumonia. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2019; 31(11): 1429–34. (Chinese)

Vermeij FH, Scholte op Reimer WJ, de Man P, van Oostenbrugge RJ, Franke CL, de Jong G, et al. Stroke-associated infection is an independent risk factor for poor outcome after acute is-chemic stroke: data from the Netherlands Stroke Survey. Cer-ebrovasc Dis 2009; 27(5): 465–71.

Chen X, Li D, Liu Y, Zhu L, Jia Y, Gao Y. Nutritional risk screening 2002 scale and subsequent risk of stroke-associated infection in ischemic stroke: The REMISE study. Front Nutr 2022; 9: 895803.

Yang J, Dai Y, Zhang Z, Chen Y. Value of Combination of the A2DS2 Score and IL-6 in Predicting Stroke-Associated Pneu-monia. Neuropsychiatr Dis Treat 2020; 16: 2353–9.

Li Y, Zhang Y, Ma L, Niu X, Chang J. Risk of stroke-associated pneumonia during hospitalization: predictive ability of combined A2DS2 score and hyperglycemia. BMC Neurol 2019; 19(1): 298.

Tu TM, Phua SS, Acharyya S, Ng WM, Oh DC. Predicting Pneumonia in Acute Ischaemic Stroke: Comparison of Five Prediction Scoring Models. Ann Acad Med Singap 2017; 46(6): 237–44.

Yoo SH, Kim JS, Kwon SU, Yun SC, Koh JY, Kang DW. Under-nutrition as a predictor of poor clinical outcomes in acute is-chemic stroke patients. Arch Neurol 2008; 65(1): 39–43.

Lee EC, Jeong YG, Jung JH, Moon HI. Validity of the Control-ling Nutritional Status score as a Nutritional Assessment Tool early after stroke. Int J Rehabil Res 2022; 45(1): 58–64.

Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R, Mil-ler L, Silliman S. Dysphagia, nutrition, and hydration in is-chemic stroke patients at admission and discharge from acute care. Dysphagia 2013; 28(1): 69–76.

Altuntas E, Karadeniz FO, Cetin S, Demir S. Relationship Be-tween Atrial Fibrillation and Controlling Nutritional Status Score in Acute Ischemic Stroke Patients. J Coll Physicians Surg Pak 2023; 33(2): 165–9.

Akimoto T, Hara M, Morita A, Uehara S, Nakajima H. Rela-tionship between Nutritional Scales and Prognosis in Elderly Patients after Acute Ischemic Stroke: Comparison of Control-ling Nutritional Status Score and Geriatric Nutritional Risk Index. Ann Nutr Metab 2021; 77(2): 116–23.

Oh J, Yu G, Ra SW. Clinical Implications of the Controlling Nutritional Status Score on Short-term Outcomes in Patients with Pleural Infection. Intern Med 2023; 62(11): 1591–8.

Arero G, Arero AG, Mohammed SH, Vasheghani-Farahani A. Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Ar-tery Disease: A Meta-Analysis. Front Nutr 2022; 9: 850641.

Aoyama T, Komori K, Nakazano M, Hara K, Tamagawa H, Ka-zama K, et al. The Clinical Influence of the CONUT Score on Survival of Patients With Gastric Cancer Receiving Curative Treatment. In Vivo 2022; 36(2): 942–8.

Wang A, He Z, Cong P, Qu Y, Hu T, Cai Y, et al. Controlling Nutritional Status (CONUT) Score as a New Indicator of Prognosis in Patients With Hilar Cholangiocarcinoma Is Supe-rior to NLR and PNI: A Single-Center Retrospective Study. Front Oncol 2020; 10: 593452.

Baysal M, Bas V, Demirci U, Gulsaran SK, Umit E, Kirkizlar HO, et al. The Utility of CONUT Score in Diffuse Large B Cell Lymphoma Patients. Niger J Clin Pract 2021; 24(8): 1194–9.

Çağliyan GA, Hacioğlu S, Koluman BU, Ilkkiliç K, Nar R, Başer MN, et al. Is CONUT score a prognostic index in patients with diffuse large cell lymphoma? Turk J Med Sci 2021; 51(4): 2112–9.

Spoletini G, Ferri F, Mauro A, Mennini G, Bianco G, Cardinale V, et al. CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study. Front Nutr 2021; 8: 793885.

Nishikawa H, Yoh K, Enomoto H, Ishii N, Iwata Y, Takata R, et al. The Relationship between Controlling Nutritional (CO-NUT) Score and Clinical Markers among Adults with Hepati-tis C Virus Related Liver Cirrhosis. Nutrients 2018; 10(9): 1185.

Published
2024/03/29
Section
Original Paper