Controlled Nutritional Status Score and Prognostic Nutritional Index for the Prediction of Postoperative Subdural Hematoma.

Abstract

Objective: To evaluate the predictive value of the prognostic nutritional index (PNI) and controlled nutritional status score (CONUT) on the neurological outcomes of patients with chronic subdural hematoma (CSDH) following burr-hole drainage.

Methods: A retrospective analysis of patients with CSDH was conducted. The CONUT and PNI values and the modified Rankin scale (mRS) scores were calculated based on the patients' conditions at the time of hospital discharge. The poor prognosis was defined as an mRS score of 3. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of CONUT and PNI for the postoperative prognosis of CSDH. Nutritional risk was defined using established cutoffs: PNI < 45 and CONUT ≥ 2.

Results: In 205 patients with CSDH, 17 patients (8.3%) had a poor prognosis. On ROC curve analysis, the area under the curve (AUC) for the CONUT in predicting poor prognosis of CSDH was 0.719 (95% Confidence Interval [CI]: 0.5867-0.8523, P=0.002). The AUC for the PNI and combined CONUT and PNI were 0.803 (95% CI: 0.7031-0.9042, P<0.001) and 0.805 (95% CI: 0.7039-0.9059, P<0.001), respectively. Moreover, multivariate logistic regression analysis showed that CONUT (OR=1.485, 95% CI: 1.096-2.011) and PNI (OR=0.850, 95% CI: 0.763-0.947) were independent risk factors for poor prognosis of CSDH following surgical intervention, after adjusting for age, hypertension, and pre-discharge intracranial fluid volume.

Conclusion: The combined score of PNI and CONUT displayed higher sensitivity and specificity, compared to PNI or CONUT alone. Therefore, the combined score might be useful in predicting the prognosis of CSDH.