Analysis Of The Correlation Between CONUT Score And Hepatitis B Cirrhosis

BackgroundsCirrhosis is one of the leading causes of hepatogenic death in the world.When infection,alcohol and other factors exist for a long time,there will be recurrent or long-term inflammation necrosis in the liver.Normal liver tissue will undergo hepatic fibrosis,structural destruction of hepatic lobules and fibrous tissue proliferation,and scar tissue will be formed in the inflammatory necrosis area.As a result,the normal liver parenchyma is replaced by fibrotic tissue and regenerated nodules,resulting in liver hardening,deformation and liver cirrhosis.Hepatitis B virus(HBV)infection is the most common cause of liver cirrhosis in China.Hepatitis B was the first cause of death in liver cirrhosis.Child score can be used to evaluate the severity of liver disease.The higher the score,the worse the liver function.As we all know,the liver is the main organ where protein,fat,carbohydrates and other nutrients are metabolized.The synthesis,metabolism and mutual transformation of the three major nutrients are carried out in the liver.Liver injury will lead to abnormal metabolism and synthesis of protein,fat,carbohydrate and other nutrients,and then lead to malnutrition.Nutritional status can predict the prognosis of various cancers,and it also has an impact on the prognosis of patients with liver cirrhosis.Malnutrition is a high incidence and serious complication in patients with liver cirrhosis,which is not only related to the increase of other complications of liver cirrhosis.Moreover,the degree of malnutrition is parallel to the severity of liver cirrhosis,which may lead to disease progression.Improving nutritional status can not only improve the quality of life of patients,but also improve the prognosis of patients with advanced liver disease.It is more and more important to evaluate the nutritional status of patients early and even to intervene.Control nutritional status(CONUT)score is a nutritional status assessment tool that reflects immune nutritional indicators.The higher the score,the worse the nutritional status.The evaluation content of CONUT score includes three objective indicators,namely serum albumin,serum total cholesterol level and peripheral blood lymphocyte.These three indexes are related to protein synthetic ability,lipid metabolism and immune ability,and can be used as nutritional indicators for patients with liver diseases.These three indicators can be easily detected in routine clinical tests,which are relatively easy to obtain,even in patients with poor coagulation function.And compared with other scores,the CONUT score is simpler,more convenient for clinical monitoring.And the clinician can complete the score without the participation of a professional medical nutrition team.It is also easy and less subjective for patients to evaluate by themselves.Aims1.Based on CONUT score,to explore malnutrition in hepatitis B patients with liver cirrhosis;2.To analyze the relationship between CONUT score and clinical indexes of patients with hepatitis B cirrhosis;3.To explore the application value of CONUT score in evaluating the nutritional status of patients with hepatitis B cirrhosis.Methods386 patients with hepatitis B-related cirrhosis were included as research subjects,which were hospitalized in Qilu Hospital of Shandong University from January 2020 to August 2022.Based on exclusion criteria and missing or duplicated data,86 patients were excluded and a total of 300 patients with hepatitis B cirrhosis were included in the study.The results of physical examination,sex,age,white blood cell(WBC),hemoglobin(HGB),platelet(PLT),hepatitis B surface antigen(HBsAg),prothrombin time(PT)and prothrombin time activity(PTA),international normalized ratio(INR),fibrinogen(FIB),y-Glutamyl transpeptidase(GGT),total bilirubin(TBIL),albumin(ALB),total protein(TP),prealbumin(PA),total bile acid(TBA),sodium(Na+),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and triglyceride(TG)were collected retrospectively after admission,and the nutritional status of the patients was evaluated by CONUT score,and compared with the evaluation based on body mass index(BMI)and ALB.According to the account of WBC and Child-Pugh classification,the malnutrition of patients in each group was further compared.SPSS 26.0 software was used for statistical analysis.Results1.Basic characteristics of the subjects:among the 300 subjects,men accounts for 73.67%(221/300)of the total number,women accounted for 26.33%(79/300)of the total number.The average age of all patients was(51.17± 10.26)years old,and the average BMI ranged from 22.80 to 27.45 kg/m2.According to Child classification,patients with Child A,Child B and Child C accounted for 27.67%(83/300),46.00%(138/300)and 26.33%(79/300),respectively.The patients were divided into two groups according to CONUT score.The patients with CONUT score<5 and CONUT score≥5 accounted for 45.33%(136/300)and 54.67%(164/300)respectively,but there was no significant difference in sex and age between the two groups(P>0.05).Compared with the patients with CONUT score<5,the patients with CONUT score≥5 had significantly worse blood coagulation function(P<0.001),lower levels of TG and TC(P<0.001),and significant lower levels of TP and PLT(P<0.001).2.The screening of malnutrition by BMI,ALB and CONUT score:there was significant difference in malnutrition screening among the three indexes(P<0.001).According to the diagnostic criteria of CONUT score,patients with malnutrition were accounted for 90.0%(270/300)of all patients,which was significantly higher than that of malnourished patients diagnosed by BMI and ALB(90.0%vs 1.7%,90.0%vs 59.3%).There was significant statistical difference among the three groups(P<0.001).The CONUT score could find more patients with moderate and severe malnutrition than ALB(P<0.001).3.The relationship between CONUT score and Child grade:there was significant difference in the distribution of CONUT score among all patients according to different Child grade(P<0.001).The higher the Child grade was,the higher the CONUT score was among the patients with Child A grade,Child B grade and Child C grade(P<0.001).The constituent ratio of patients with moderate and severe malnutrition was also significantly different among the three Child grades,and the proportion of patients with moderate and severe malnutrition was the highest in patients with Child C grade(P<0.001)compared with patients with Child B and Child C.4.The relationship between CONUT score and leukocyte count:the constituent ratio of patients with CONUT score≥5 was significantly different among the three groups with WBC lower than normal lower limit,WBC normal and WBC higher than normal upper limit(P<0.001).The constituent ratio of patients with CONUT score≥ 5 in abnormal WBC group was significantly higher than that in normal WBC group(P<0.001).In the normal WBC group,the constituent ratio of patients with CONUT score≥ 5 in Child A grade was the lowest,and there was significant difference in distribution among different Child grades(P<0.001).In the group with abnormal WBC,the constituent ratio of patients with CONUT score>5 in Child A grade was the lowest,and the difference was statistically significant(P<0.001).5.Relationship between CONUT score and clinical indicators:Spearman correlation analysis showed that TBIL,TBA,INR,PT,ascites and Child scores had significant positive correlation with CONUT scores(P<0.05),while GGT,TP,PA,TG,HDL-C,LDL-C,Na+,HGB,PLT,HBsAg,PTA,FIB had significant negative correlation with CONUT scores(P<0.05).6.Regression analysis of factors related to CONUT score:multiple linear regression analysis showed that the CONUT score increased with the decrease of TP,TG,HDL-C,Na+,HGB,PLT and PTA(P<0.05).Multivariate Logistic regression analysis showed that the lower the levels of TP,TG,HDL-C,Na+,HGB,PLT and PTA,the more likely they were moderate and severe malnutrition(P<0.05).Conclusions1.Compared with a single objective index,CONUT score is a more sensitive tool for nutritional status assessment in patients with chronic hepatitis B related liver cirrhosis.2.According to the CONUT score,most patients with liver cirrhosis are malnourished.The more severe the Child grade,the higher the CONUT score,and it is not affected by the white blood cells of the patients.3.TP,TG,HDL-C,Na+,HGB,PLT and PTA were negatively correlated with moderate and severe malnutrition.