Correlation Between Controlling Nutritional Status(CONUT) Score And Clinical Characteristics Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:To investigate the association between the nutritional control status score（CONUT score）and the clinical characteristics of patients with AECOPD.To assess the predictive value of the controlled nutritional status score（CONUT score）for reacute exacerbation of AECOPD.Methods:Referring to the diagnostic criteria of chronic obstructive pulmonary disease in the"Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease（revised version 2021）",214 patients with AECOPD admitted to Ganzhou People’s Hospital from December 2020 to December 2021 were selected.Basic information（age,gender,height,weight,BMI（body mass index）,smoking history）,laboratory tests:routine blood indices such as white blood cell count（WBC）,lymphocyte count（LYM）,hemoglobin（Hb）,serum albumin（ALB）,total cholesterol（TC）,serum creatinine（Cr）,serum uric acid（UA）,C-reactive protein（CRP）and other biochemical indexes.Pulmonary function tests:first second exertional expiratory volume（FEV₁）,first second exertional expiratory volume as a percentage of expected value（FEV₁%pre）,first second exertional expiratory volume as a percentage of exertional lung volume（FEV₁/FVC）,exertional lung volume（FEV）,and peak expiratory flow（PEF）.All enrolled patients were followed up by telephone and hospital information systems to record their acute exacerbation events within 1 year.The enrolled patients were divided into well-nourished,mildly malnourished,and moderately severely malnourished groups according to the scoring criteria of the CONUT score,Patients were divided into a high-risk group for acute exacerbation and a low-risk group for acute exacerbation according to the presence or absence of re-hospitalization due to acute exacerbation of COPD within 1 year after hospital discharge,and SPSS 22.0 statistical software was applied for statistical description to compare the differences in demographic information,clinical data,and pulmonary function levels between the different nutritional status subgroups,and to analyze the relationship between the different subgroups and the collected general information,laboratory tests,and pulmonary function tests were correlated.Variables were screened by multi-factor logistic analysis,and corrected risk prediction models were established by applying logistic regression.ROC curves were used to evaluate the predictive value of the prediction model for whether AECOPD was acutely exacerbated.Results:1.214 patients with acute exacerbation of COPD were grouped according to the CONUT score criteria.80 cases（18.69%）were in the normal nutrition group（CONUT score 0-1）;102 cases（47.66%）were in the mild malnutrition group（CONUT score 2-4）;and 72 cases（33.65%）were in the moderate to severe malnutrition group（CONUT score 5-12）.Grouped by whether they were hospitalized for acute exacerbation within the previous year,98 cases（45.79%）were in the high-risk group for acute exacerbation and 116 cases（54.21%）were in the low-risk group for acute exacerbation.2.The differences in BMI,proportion of acute exacerbations within 1 year,hemoglobin（Hb）,lymphocyte count（LYM）,albumin（ALB）,total cholesterol（TC）,C-reactive protein（CRP）,first second exertional expiratory volume（FEV₁）,and one second exertional expiratory volume as a percentage of exertional spirometry（FEV₁/FVC）among patients in different nutritional subgroups were The differences were statistically significant（P<0.05）.3.CONUT scores were positively correlated with C-RP and risk of acute exacerbation within 1 year in patients with acute exacerbation of COPD（r values 0.363,0.501,P<0.05）;CONUT scores were negatively correlated with BMI,Hb,LYM,ALB,TC,FEV1,FEV,FEV1%pre,FEV1/FVC（r values-0.358,-0.464,-0.579,-0.640,-0.645,-0.214,-0.201,-0.247,-0.139,P<0.05）.4.The differences in CONUT score,hemoglobin（Hb）,lymphocyte count（LYM）,albumin（ALB）,total cholesterol（TC）,C-reactive protein（CRP）,first second exertional expiratory volume（FEV₁）,and one second exertional expiratory volume as a percentage of exertional spirometry（FEV₁/FVC）were statistically significant among patients in different acute exacerbation risk groups（P<0.05）.5.Multi-factor binary logistic regression analysis showed that CONUT score was an independent risk factor for acute exacerbation of COPD（OR 1.817,95%CI1.043～3.167,P<0.05）,and the prediction model obtained was:Logit（P）=-0.813+0.597×CONUT score.6.The area under the ROC curve of the prediction model was 0.806,the sensitivity was:83.7%,the specificity was:63.8%,and the highest Uden index obtained according to the sensitivity and specificity was:0.475.the area included under the ROC curve constructed with CONUT score alone was 0.775,and the prediction model had stronger predictive ability.The optimal cutoff value for this model was a CONUT score of 3.It can be divided into a high risk group for acute exacerbation with CONUT score≥3and a low risk group for acute exacerbation with CONUT score<3.Conclusion:1.The nutritional status of patients with acute exacerbation of COPD is related to various factors such as hematological nutritional indicators and lung function.2.The higher the CONUT score in acute exacerbation of COPD,the greater the degree of dyspnea and the higher the CRP;the lower the BMI,Hb,LYM,ALB and TC.3.The CONUT score is an independent risk factor for acute exacerbation of COPD,and the obtained prediction model is a valid predictor of admission for acute exacerbation of COPD.