Objective: To investigate the predictive value of the preoperative controlling nutritional status (CONUT) score combined with C-reactive protein (CRP) for postoperative intensive care unit (ICU) admission in frail patients scheduled for surgery.
Methods: A total of 344 frail patients scheduled for surgery were enrolled from seven hospitals, 127 males and 217 females, aged 60-85 years, BMI 13.0-36.6 kg/m2, ASA physical status Ⅰ-Ⅲ. Patients were divided into two groups based on postoperative ICU admission: the ICU group and the non-ICU group. Preoperative serum albumin (ALB) concentration, peripheral blood lymphocyte count (LYM), total cholesterol(TC) concentration, and CRP concentration were collected within 3 days before surgery, and the CONUT score was calculated. Univariate analysis was used to compare CONUT score, CRP concentration, and surgical characteristics. Multivariate Logistic regression analysis was employed to assess the association between the binary CONUT score, CRP concentration, and postoperative ICU admission. The receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was used to evaluate the predictive value of preoperative CONUT score, preoperative CRP, and combined detection for postoperative ICU admission in frail patients. The model was internally validated using the Bootstrap method.
Results: Postoperative ICU admission occurred in twenty-one patients (6.1%). The univariate analysis showed that the ICU group had significantly older age than the non-ICU group (P < 0.05). Compared with the non-ICU group, the ICU group showed greater sedentary behavior within one week, higher age-adjusted Charlson comorbidity index (ACCI) scores, a higher proportion of patients undergoing general anesthesia, greater intraoperative blood transfusion volume, higher CRP concentration, and a larger proportion of patients with high CONUT score ( P < 0.05). Compared with group NI, group Ⅰ demonstrated significantly lower activities of daily living (ADL) scores and LYM (P < 0.05). The multivariable logistic regression further showed that elevated CONUT score (OR = 5.091, 95% CI 1.010-25.657, P = 0.049) and elevated preoperative CRP concentration (OR = 1.014, 95% CI 1.003-1.025, P = 0.015) were identified as independent risk factors for postoperative ICU admission in frail patients. The AUC of preoperative CONUT score, preoperative CRP concentration, and combined detection to predict postoperative ICU admission in frail patients were 0.680 (95% CI 0.585-0.775), 0.689 (95% CI 0.559-0.818), and 0.751 (95% CI 0.666-0.835), respectively. The two combined predictors showed good performance, with an AUC of 0.747, and sensitivity was 71.4%, and specificity was 73.7% in the Bootstrap validation.
Conclusion: The combination of the preoperative CONUT score and CRP concentration can effectively predict postoperative ICU admission in frail surgical patients. This readily available assessment tool is suitable for clinical implementation. |
