Correlation Study Between CONUT Score And Cardiovascular Disease In Maintenance Hemodialysis Patients

Objective:To assess the nutritional status of 424 maintenance hemodialysis(MHD)patients based on Controlling Nutritional Status(CONUT)score,and investigate the correlation and predictive value of CONUT score with cardiovascular disease(CVD)in MHD patients.Methods:Baseline data of MHD patients who were newly hospitalized in our hemodialysis center from January 1,2014 to June 30,2020 were collected.The endpoint was cardiovascular events.According to the CONUT score,patients were divided into normal group(CONUT 0-1),mild malnourished group(CONUT 2-4)and moderate-severe malnourished group(CONUT≥5).The clinical data and outcome of MHD patients in three differential groups were compared.The relationship between COUNT score and other clinical variables were explored by Spearmen correlation analysis.Single factors and multi-factors logistics regression analysis were performed to identify the independent risk factors influencing the cardiovascular events of MHD patients,and ROC curve was performed to investigate the predictive ability of CONUT score and age on cardiovascular events of MHD patients.Results:Of 424 MHD patients,278(65.6%)were male,the average age was59.78±15.07 years,159(37.5%)cases had cardiovascular events.According to CONUT score,31(7.3%)were in the normal group,160(37.7%)were in the mild malnourished group,233(55.0%)were in moderate-severe malnourished group.1.Red blood cell count,hemoglobin,lymphocyte count,total protein,serum albumin,creatinine,triglyceride,total cholesterol,low density lipoprotein cholesterol,serum calcium levels in moderate-severe malnourished group were significantly lower than those in other two groups(P<0.05).Year,the proportion of patients with diabetes,red blood distribution width,CPR and the length of hospitalization at the time of first hemodialysis treatment were significantly higher than those in other two groups(P<0.05).2.CONUT score was positively correlated with age,diabetes mellitus,the length of hospitalization at the time of first hemodialysis treatment and red cell distribution width(P<0.05),and was negative correlated with red cell count,total protein,serum albumin,creatinine,triglyceride,total cholesterol,low density lipoprotein cholesterol,serum calcium(P<0.05).3.Of 159 MHD patients with cardiovascular events during follow-up,including 3(9.7%)cases in the normal group,38(23.8%)cases in mild malnourished group,118(50.6%)cases in moderate-severe malnourished group,the incidence of cardiovascular events showed an increasing trend with the deterioration of nutritional status(P<0.05).4.CONUT score value and the proportion of moderate-severe malnutrition in MHD patients with cardiovascular events were significantly higher than those without cardiovascular events.Logistic regression analysis showed that CONUT score and age were independent risk factors influencing the cardiovascular events of MHD patients(P<0.05).5.The AUC of CONUT score and age for predicting cardiovascular events in MHD patients respectively was 0.683(95%CI: 0.632-0.735,P<0.001)and 0.702(95%CI: 0.652-0.753,P<0.001).The optimum cut-off value of CONUT score was4.5(≥5 according to the actual record)with a 74.2% sensitivity and 56.6%specificity,respectively.Age = 68.5 had a maximizing Youden index with a 49.1%sensitivity and 81.1% specificity,respectively.Conclusion:1.Most MHD patients were often found in a state of malnutrition based on CONUT score during the first hemodialysis,mainly moderate to severe malnutrition.2.The CONUT score is a independent risk factor for cardiovascular events of MHD patients,and MHD patients with moderate-severe malnutrition(CONUT score≥5)are more likely to suffer from cardiovascular events.