Admission CONUT Score and Clinical Outcomes in Critically Ill Pediatric Patients: A Retrospective Cohort Study
Abstract
Background: Malnutrition is common among hospitalized children and may be associated with adverse outcomes in pediatric intensive care units (PICUs). The Controlling Nutritional Status (CONUT) score is an inexpensive laboratory-based screening tool derived from serum albumin, total cholesterol, and total lymphocyte count; however, pediatric critical-care evidence remains limited. Objective: To determine nutritional status at PICU admission using the CONUT score and examine its association with complications, length of stay, and mortality. Methods: This retrospective cohort study included 380 consecutive patients aged >28 days and <19 years who were admitted to the PICU of Hospital Pediátrico Docente de Centro Habana, Havana, Cuba, from September 2023 through September 2024 and remained for at least 24 hours. Admission CONUT categories were analyzed in relation to demographic and clinical variables. Associations were assessed using chi-square tests with a two-sided significance level of 0.05. Results: At admission, 297 patients (78.16%) had a normal CONUT score, 36 (9.47%) had mild malnutrition, 28 (7.37%) had moderate malnutrition, and 19 (5.00%) had severe malnutrition. Admission CONUT category was associated with PICU length of stay and discharge status (both p<0.001). Mortality within CONUT categories was 4.0% for normal status, 0% for mild malnutrition, 21.4% for moderate malnutrition, and 36.8% for severe malnutrition. Among 83 patients with at least one complication, 168 complication events were recorded; event distributions differed across CONUT categories for most reported complications. Conclusions: Higher CONUT categories at PICU admission were associated with longer stays, complications, and mortality. Because albumin, cholesterol, and lymphocyte count are affected by inflammation and critical illness, CONUT should be considered an adjunctive risk-screening tool rather than a stand-alone diagnosis of malnutrition. Prospective studies with multivariable adjustment are needed to establish prognostic performance in critically ill children.