Peran Skor CONUT dalam Prediksi Prognosis Pasien dengan Ulkus Kaki Diabetik
Abstract
Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus, associated with high morbidity, amputation, and mortality. Nutritional factors play a crucial role in wound healing, and malnutrition has been shown to increase the risk of complications and worsen prognosis. One of the objective instruments increasingly used to assess nutritional status is the Controlling Nutritional Status (CONUT) score. This score is calculated based on three simple laboratory parameters: serum albumin, total cholesterol, and peripheral lymphocyte count. Recent studies have demonstrated that the CONUT score not only reflects nutritional status but also serves as an independent predictor of ulcer healing, amputation risk, and mortality in patients with diabetic foot. Patients with high CONUT scores (≥5) generally present with poorer outcomes, including higher rates of major amputation and reduced overall survival, compared with those with lower scores. Therefore, incorporating the CONUT score into clinical practice may provide a simple, cost-effective, and reliable tool for risk assessment and therapeutic decision-making. This review highlights the mechanisms, validation, and clinical implications of the CONUT score in the prognostication of diabetic foot ulcer patients.
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Raja JM, Maturana MA, Kayali S, Khouzam A, Efeovbokhan N. Diabetic foot ulcer: A comprehensive review of pathophysiology and management modalities. World journal of clinical cases. 2023 Mar;11(8):1684–93.
Armstrong DG, Tan T-W, Boulton AJM, Bus SA. Diabetic Foot Ulcers: A Review. JAMA [Internet]. 2023 Jul 3;330(1):62–75. Available from: https://doi.org/10.1001/jama.2023.10578
Halschou-Jensen PM, Sauer J, Bouchelouche P, Fabrin J, Brorson S, Ohrt-Nissen S. Improved Healing of Diabetic Foot Ulcers After High-dose Vitamin D: A Randomized Double-blinded Clinical Trial. The International Journal of Lower Extremity Wounds [Internet]. 2021 Jul 2;22(3):466–74. Available from: https://doi.org/10.1177/15347346211020268
De UlÃbarri JI, González-Madroño A, de Villar NGP, González P, González B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutricion hospitalaria. 2005;20(1):38–45.
Bengelloun AK, Ortega GJ, Ancochea J, Sanz-Garcia A, RodrÃguez-Serrano DA, Fernández-Jiménez G, et al. Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes. Chinese medical journal. 2021 Oct;135(2):187–93.
LIU C, ZHU M, YANG X. Controlling nutritional status score as a predictive marker of in-hospital mortality in older adult patients. Front Nutr, 2021, 8, 738045 [2022-07-09]. 2021.
Zhu Y, Xu H, Wang Y, Feng X, Liang X, Xu L, et al. Risk factor analysis for diabetic foot ulcer-related amputation including Controlling Nutritional Status score and neutrophil-to-lymphocyte ratio. International Wound Journal [Internet]. 2023 Dec 1;20(10):4050–60. Available from: https://doi.org/10.1111/iwj.14296
Shi H-Y, Zhu P, Zhang M, Wang A-H. [Correlation Between Controlling Nutritional Status Scores and Amputation Risks in Patients with Diabetic Foot Ulcers]. Sichuan da xue xue bao Yi xue ban = Journal of Sichuan University Medical science edition. 2022 Nov;53(6):993–7.
Kokura Y, Kimoto K, Okada Y, Kawakita S. The Controlling Nutritional Status score as a functional prognostic marker in patients with acute stroke: A multicenter retrospective cohort study. Nutrition [Internet]. 2020;79–80:110889. Available from: https://www.sciencedirect.com/science/article/pii/S0899900720301726
Miano N, Di Marco M, Alaimo S, Coppolino G, L’Episcopo G, Leggio S, et al. Controlling Nutritional Status (CONUT) Score as a Potential Prognostic Indicator of In-Hospital Mortality, Sepsis and Length of Stay in an Internal Medicine Department. Nutrients. 2023 Mar;15(7).
Lee EC, Jeong YG, Jung JH, Moon HI. Validity of the Controlling Nutritional Status score as a Nutritional Assessment Tool early after stroke. International Journal of Rehabilitation Research [Internet]. 2022;45(1). Available from: https://journals.lww.com/intjrehabilres/Fulltext/2022/03000/Validity_of_the_Controlling_Nutritional_Status.8.aspx
International Diabetes Federation. Diabetes. Brussels: IDF; 2021.
McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers. Diabetes Care. 2023;46(1):209–21.
Boyko EJ, Zelnick LR, Braffett BH, Pop-Busui R, Cowie CC, Lorenzi GM, et al. Risk of foot ulcer and lower-extremity amputation among participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care. 2022;45(2):357–64.
Yang L, Rong G-C, Wu Q-N. Diabetic foot ulcer: challenges and future. World Journal of Diabetes. 2022;13(12):1014.
Stirban A. Microvascular dysfunction in the context of diabetic neuropathy. Current diabetes reports. 2014;14(11):541.
Ropper AH, Samuel MA, Klein JP, et al. Adams and Victor’s Principles of Neurology. 11th ed. Boston: Mc Graw Hill Companies Inc; 2019.
Monteiroâ€Soares M, Boyko EJ, Jeffcoate W, Mills JL, Russell D, Morbach S, et al. Diabetic foot ulcer classifications: a critical review. Diabetes/metabolism research and reviews. 2020;36:e3272.
Mills Sr JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). Journal of vascular surgery. 2014;59(1):220–34.
Jameson J, Fauci A, Kasper D, Hauser S, Longo D, Loscalzo J. Harrison’s Principles of Internal Medicine 20th ed. New York NY, McGraw Hill Education. 2018;
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. Journal of Parenteral and Enteral Nutrition. 2019;43(2):181–93.
Hong J, Huang Q-Q, Liu W-Y, Hu X, Jiang F-F, Xu Z-R, et al. Three nutritional indices are effective predictors of mortality in patients with type 2 diabetes and foot ulcers. Frontiers in Nutrition. 2022;9:851274.
Chamberlain RC, Fleetwood K, Wild SH, Colhoun HM, Lindsay RS, Petrie JR, et al. Foot Ulcer and Risk of Lower Limb Amputation or Death in People With Diabetes: A National Population-Based Retrospective Cohort Study. Diabetes care. 2022 Jan;45(1):83–91.
Schwegler I, von Holzen A, Gutzwiller J-P, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. The British journal of surgery. 2010 Jan;97(1):92–7.
Mehta A, De Paola L, Pana TA, Carter B, Soiza RL, Kafri MW, et al. The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies. Nutrition reviews. 2022 Nov;80(12):2275–87.
Rouland A, Fourmont C, Sberna AL, Aho Glele LS, Mouillot T, Simoneau I, et al. Malnutrition in type 2 diabetic patients does not affect healing of foot ulcers. Acta diabetologica. 2019 Feb;56(2):171–6.
Sorg H, Tilkorn DJ, Hager S, Hauser J, Mirastschijski U. Skin Wound Healing: An Update on the Current Knowledge and Concepts. European Surgical Research. 2017;58(1–2):81–94.
DOI: https://doi.org/10.33085/mdj.v2i1.6877
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