CONUT score at ICU discharge predicts long-term all-cause mortality risk in elderly survivors of pneumonia-induced sepsis
4 affiliations
- 1Department of Endocrinology and Metabolism, National Key Clinical Construction Specialty, Guangxi Academy of Medical Sciences & The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- 2Health Management Center, Guangxi Academy of Medical Sciences & The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- 3Clinical Laboratory, Xiaxian People's Hospital, Yuncheng, Shanxi, China
- 4Department of Endocrinology and Respiratory, The Third People's Hospital of Nanning, Nanning, Guangxi, China
Abstract
Background and objectivesAlthough the Controlling Nutritional Status (CONUT) score has been confirmed to be associated with short-term mortality in intensive care unit (ICU) patients with sepsis, evidence on long-term post-ICU mortality remains limited. This study assessed its prognostic performance for long-term all-cause mortality in elderly survivors of pneumonia-induced sepsis and compared it with several immunoinflammatory nutritional indices.MethodsFrom the initial pool of 620 candidates, we screened 510 first-episode sepsis survivors with no sepsis recurrence more than 3 months after ICU discharge. We subsequently established a multicenter ambispective longitudinal cohort of 461 eligible participants for prospective follow-up, with a median follow-up period of 36 months. Using a complete-case approach with ICU discharge as time zero, we assessed the association between CONUT and mortality across the CONUT score tertiles: T1 (score 0–3, n = 162), T2 (4–6, n = 172), and T3 (7–12, n = 127). Sensitivity analyses were conducted to address selection, immortal-time, and landmark biases.ResultsLong-term risk of all-cause mortality increased stepwise across CONUT tertiles (24.07% vs. 37.21% vs. 58.27%; p < 0.0001). Kaplan–Meier analysis demonstrated significantly lower survival in patients with higher CONUT scores (log-rank, p < 0.0001). Multivariable Cox regression (Model III) revealed that one tertile increase in CONUT was associated with a 23.3% higher mortality risk (hazard ratio (HR) = 1.233, 95% confidence interval (CI) = 1.004–1.515; p for trend = 0.036), while the highest CONUT tertile carried a 51.6% increased mortality risk (HR = 1.516, 95% CI = 1.001–2.296; p = 0.039). Stratified analyses detected gender-related effect heterogeneity (p for interaction = 0.034). Restricted cubic spline (RCS) modeling confirmed a significant positive dose–response association between CONUT and mortality (p for overall < 0.001, p for nonlinear = 0.575). Multivariable linear regression evidenced that each one-tertile CONUT increase produced measurable changes in immunoinflammatory nutrition-derived indices (calculated as Model III |β| × tertile interval (3.0), with positive β values indicating increases and negative β values indicating reductions): blood urea nitrogen-to-albumin ratio (BAR) increase of 0.2889 (β = 0.0963), neutrophil-to-lymphocyte ratio (NLR) increase of 0.5313 (β = 0.1771), platelet-to-lymphocyte ratio (PLR) increase of 0.2721 (β = 0.0907), and lymphocyte to high-density lipoprotein ratio (LHR) reduction of 0.126 (β = −0.0420) (all p < 0.01). Time-dependent AUC analysis showed that CONUT prognostic discrimination was comparable to BAR and superior to NLR, PLR, and LHR over a median 36-month follow-up (DeLong test, all p for ΔAUC < 0.05). Decision curve analysis (DCA) illustrated that the CONUT model provided greater overall net benefit than the other markers. Time-dependent integrated discrimination improvement (IDI), time-dependent continuous net reclassification improvement (NRI), a mutually adjusted Cox model, a bidirectional incremental C-index, and calibration curve analyses indicated that CONUT was a core prognostic marker. BAR further improved prognostic performance when added to the CONUT-based model, whereas NLR, PLR, and LHR added little incremental predictive value.ConclusionThe bedside CONUT score measured at ICU discharge may be associated with long-term all-cause mortality risk in older sepsis survivors. Further research is required before these findings can inform nutritional interventions in routine clinical practice.
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BibTeX
@article{feng2026conut,
title = {{CONUT score at ICU discharge predicts long-term all-cause mortality risk in elderly survivors of pneumonia-induced sepsis}},
author = {Ling Feng and Xiaoying Wei and Zhenwei Zhai and Yuan Zheng and Yanni Tan and Jingxia Sun and Wenxin Chu and Wensheng Lu},
journal = {Frontiers in Nutrition},
year = {2026},
month = nov,
doi = {10.3389/fnut.2026.1914318},
url = {https://doi.org/10.3389/fnut.2026.1914318},
note = {CC BY},
}
RIS
TY - JOUR
TI - CONUT score at ICU discharge predicts long-term all-cause mortality risk in elderly survivors of pneumonia-induced sepsis
AU - Ling Feng
AU - Xiaoying Wei
AU - Zhenwei Zhai
AU - Yuan Zheng
AU - Yanni Tan
AU - Jingxia Sun
AU - Wenxin Chu
AU - Wensheng Lu
PY - 2026
DA - 2026/11/03
JO - Frontiers in Nutrition
DO - 10.3389/fnut.2026.1914318
UR - https://doi.org/10.3389/fnut.2026.1914318
AB - Background and objectivesAlthough the Controlling Nutritional Status (CONUT) score has been confirmed to be associated with short-term mortality in intensive care unit (ICU) patients with sepsis, evidence on long-term post-ICU mortality remains limited. This study assessed its prognostic performance for long-term all-cause mortality in elderly survivors of pneumonia-induced sepsis and compared it with several immunoinflammatory nutritional indices.MethodsFrom the initial pool of 620 candidates, we screened 510 first-episode sepsis survivors with no sepsis recurrence more than 3 months after ICU discharge. We subsequently established a multicenter ambispective longitudinal cohort of 461 eligible participants for prospective follow-up, with a median follow-up period of 36 months. Using a complete-case approach with ICU discharge as time zero, we assessed the association between CONUT and mortality across the CONUT score tertiles: T1 (score 0–3, n = 162), T2 (4–6, n = 172), and T3 (7–12, n = 127). Sensitivity analyses were conducted to address selection, immortal-time, and landmark biases.ResultsLong-term risk of all-cause mortality increased stepwise across CONUT tertiles (24.07% vs. 37.21% vs. 58.27%; p < 0.0001). Kaplan–Meier analysis demonstrated significantly lower survival in patients with higher CONUT scores (log-rank, p < 0.0001). Multivariable Cox regression (Model III) revealed that one tertile increase in CONUT was associated with a 23.3% higher mortality risk (hazard ratio (HR) = 1.233, 95% confidence interval (CI) = 1.004–1.515; p for trend = 0.036), while the highest CONUT tertile carried a 51.6% increased mortality risk (HR = 1.516, 95% CI = 1.001–2.296; p = 0.039). Stratified analyses detected gender-related effect heterogeneity (p for interaction = 0.034). Restricted cubic spline (RCS) modeling confirmed a significant positive dose–response association between CONUT and mortality (p for overall < 0.001, p for nonlinear = 0.575). Multivariable linear regression evidenced that each one-tertile CONUT increase produced measurable changes in immunoinflammatory nutrition-derived indices (calculated as Model III |β| × tertile interval (3.0), with positive β values indicating increases and negative β values indicating reductions): blood urea nitrogen-to-albumin ratio (BAR) increase of 0.2889 (β = 0.0963), neutrophil-to-lymphocyte ratio (NLR) increase of 0.5313 (β = 0.1771), platelet-to-lymphocyte ratio (PLR) increase of 0.2721 (β = 0.0907), and lymphocyte to high-density lipoprotein ratio (LHR) reduction of 0.126 (β = −0.0420) (all p < 0.01). Time-dependent AUC analysis showed that CONUT prognostic discrimination was comparable to BAR and superior to NLR, PLR, and LHR over a median 36-month follow-up (DeLong test, all p for ΔAUC < 0.05). Decision curve analysis (DCA) illustrated that the CONUT model provided greater overall net benefit than the other markers. Time-dependent integrated discrimination improvement (IDI), time-dependent continuous net reclassification improvement (NRI), a mutually adjusted Cox model, a bidirectional incremental C-index, and calibration curve analyses indicated that CONUT was a core prognostic marker. BAR further improved prognostic performance when added to the CONUT-based model, whereas NLR, PLR, and LHR added little incremental predictive value.ConclusionThe bedside CONUT score measured at ICU discharge may be associated with long-term all-cause mortality risk in older sepsis survivors. Further research is required before these findings can inform nutritional interventions in routine clinical practice.
SN - 2296-861X
ER -