Predictive Role of Preoperative Controlled Nutritional Status Score on Prolonged Mechanical Ventilation after Heart Valve Surgery

Authors

  • Li Yang Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China
  • Lu Chen Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China
  • Jie Chen Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China
  • Yuanzhang Liu Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China
  • Chunmei Liu Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China
  • Xuelin Yang Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China
  • Xiaoyan Chen Department of Cardiovascular Surgery, General Hospital of Western Theater Command, 610083 Chengdu, Sichuan, China

DOI:

https://doi.org/10.59958/hsf.7973

Keywords:

controlled nutritional status, heart valve surgery, prolonged mechanical ventilation, nutritional status

Abstract

Background: Postoperative prolonged mechanical ventilation (MV) in patients with heart valve disease (HVD) is usually concomitant with poor prognosis. Its relationship with preoperative nutritional status still remains unclear. The present study intends to explore the influence of preoperative controlled nutritional status (CONUT) score on early postoperative outcomes and its predictive role in prolonged MV. Methods: HVD patients receiving cardiac surgeries in our department from January 2022 to December 2023 were retrospectively selected. CONUT score was calculated according to the level of serum albumin, total cholesterol and lymphocyte counts. When the CONUT score was greater than or equal to 3, patients were included in high CONUT group, and the other patients were included in low CONUT score group. Propensity score matching (PSM) was used to adjust baseline characteristics. Results: A total of 411 patients were included, of which 129 patients had the preoperative CONUT score greater than or equal to 3 points, accounting for 31.4%. After adjustment at a ratio of 1:2, 103 patients were included in high CONUT group while 206 patients were included in low CONUT group. The incidence of postoperative ventilator associated pneumonia (VAP) in high CONUT group was significantly higher than that in low CONUT group (p = 0.039). Length of ICU stay showed up a significant extension in high CONUT group compared with low CONUT group (p = 0.041). Significantly prolonged MV time could be observed in high CONUT group compared with low CONUT group (p = 0.022). The proportion of patients receiving MV over 48 h and 72 h in high CONUT group significantly increased (p = 0.020 and 0.009 respectively) except for MV over 24 h. MV time of all patients was found to be significantly correlated with CONUT score (r = 0.186, p = 0.001). The area under the curve (AUC) for CONUT predicting MV >48 h was 0.625 (p = 0.008), with sensitivity of 0.419 and specificity of 0.808. The AUC for CONUT predicting MV >72 h was 0.691 (p = 0.003), with sensitivity of 0.545 and specificity of 0.801. Conclusions: Preoperative CONUT score had an accurate predictive role of postoperative prolonged MV and early poor prognosis in HVD patients, which deserves much attention to improve clinical outcomes.

References

Yang Y, Wang Z, Chen Z, Wang X, Zhang L, Li S, et al. Current status and etiology of valvular heart disease in China: a population-based survey. BMC Cardiovascular Disorders. 2021; 21: 339.

Nicolotti D, Grossi S, Nicolini F, Gallingani A, Rossi S. Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review. Journal of Clinical Medicine. 2023; 12: 497.

Diaz-Castrillon CE, Brown JA, Navid F, Serna-Gallegos D, Yousef S, Thoma F, et al. The impact of prolonged mechanical ventilation after acute type A aortic dissection repair. The Journal of Thoracic and Cardiovascular Surgery. 2024; 167: 1672–1679.e2.

Savatmongkorngul S, Yuksen C, Sunsuwan N, Sricharoen P, Jenpanitpong C, Maijan K, et al. Mortality in patients receiving prolonged invasive mechanical ventilation time in the emergency department: A retrospective cohort study. International Journal of Critical Illness and Injury Science. 2022; 12: 77–81.

Efremov SM, Ionova TI, Nikitina TP, Vedernikov PE, Dzhumatov TA, Ovchinnikov TS, et al. Effects of malnutrition on long-term survival in adult patients after elective cardiac surgery. Nutrition (Burbank, Los Angeles County, Calif.). 2021; 83: 111057.

Juliana N, Abd Aziz NAS, Maluin SM, Abu Yazit NA, Azmani S, Kadiman S, et al. Nutritional Status and Post-Cardiac Surgery Outcomes: An Updated Review with Emphasis on Cognitive Function. Journal of Clinical Medicine. 2024; 13: 4015.

Cai YS, Li XY, Ye X, Li X, Fu YL, Hu B, et al. Preoperative controlling nutritional status score (CONUT) predicts postoperative complications of patients with bronchiectasis after lung resections. Frontiers in Nutrition. 2023; 10: 1000046.

Dang C, Wang M, Zhu F, Qin T, Qin R. Controlling nutritional status (CONUT) score-based nomogram to predict overall survival of patients with pancreatic cancer undergoing radical surgery. Asian Journal of Surgery. 2022; 45: 1237–1245.

Dalmiglio C, Brilli L, Campanile M, Ciuoli C, Cartocci A, Castagna MG. CONUT Score: A New Tool for Predicting Prognosis in Patients with Advanced Thyroid Cancer Treated with TKI. Cancers. 2022; 14: 724.

Tóth K, Szabó A, Nagy Á, Szabó D, Szécsi B, Eke C, et al. Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery. Annals of Palliative Medicine. 2021; 10: 11333–11347.

Usta S, Engin M. Investigation of the effects of preoperative nutritional status scores on renal injury after cardiac surgery in elderly patients. European Review for Medical and Pharmacological Sciences. 2022; 26: 9345–9352.

Unosawa S, Taoka M, Osaka S, Yuji D, Kitazumi Y, Suzuki K, et al. Is malnutrition associated with postoperative complications after cardiac surgery? Journal of Cardiac Surgery. 2019; 34: 908–912.

Ogawa M, Izawa KP, Satomi-Kobayashi S, Kitamura A, Ono R, Sakai Y, et al. Poor preoperative nutritional status is an important predictor of the retardation of rehabilitation after cardiac surgery in elderly cardiac patients. Aging Clinical and Experimental Research. 2017; 29: 283–290.

Arai Y, Kimura T, Takahashi Y, Hashimoto T, Arakawa M, Okamura H. Preoperative nutritional status is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery. General Thoracic and Cardiovascular Surgery. 2018; 66: 632–640.

Hazer S, Gülhan SŞE, Solak N, Yenibertiz D, Akıllı MS, Sayilir Guven E, et al. The Effect of Prognostic Nutritional Index in Postoperative Infection Following Lobectomy in Non-Small Cell Lung Cancer Patients. Cureus. 2023; 15: e37611.

Kilinc AA, Beser OF, Ugur EP, Cokugras FC, Cokugras H. The effects of nutritional status and intervention on pulmonary functions in pediatric cystic fibrosis patients. Pediatrics International: Official Journal of the Japan Pediatric Society. 2021; 63: 316–322.

Huang L, He R, Sun X, Lv J, Chen S. Association of Controlling Nutritional Status Score With Adverse Outcomes in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Angiology. 2023; 74: 149–158.

Saito A, Amiya E, Hatano M, Shiraishi Y, Nitta D, Minatsuki S, et al. Controlling Nutritional Status Score As a Predictive Marker for Patients With Implantable Left Ventricular Assist Device. ASAIO Journal (American Society for Artificial Internal Organs: 1992). 2020; 66: 166–172.

Ignacio de Ulíbarri J, González-Madroño A, de Villar NGP, González P, González B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutricion Hospitalaria. 2005; 20: 38–45.

Michaud L, Dureau P, Kerleroux B, Charfeddine A, Regan M, Constantin JM, et al. Development and Validation of a Predictive Score for Prolonged Mechanical Ventilation After Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2022; 36: 825–832.

Hessels L, Coulson TG, Seevanayagam S, Young P, Pilcher D, Marhoon N, et al. Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33: 2709–2716.

Published

2024-11-17

How to Cite

Yang, L., Chen, L., Chen, J., Liu, Y., Liu, C., Yang, X., & Chen, X. (2024). Predictive Role of Preoperative Controlled Nutritional Status Score on Prolonged Mechanical Ventilation after Heart Valve Surgery. The Heart Surgery Forum, 27(11), E1289-E1294. https://doi.org/10.59958/hsf.7973

Issue

Section

Article