Nutritional Assessment Using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) Score Predicts Wound Healing In Patients with Diabetic Foot Ulcers

Abstract

Aims The aim was to examine whether the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are predictors of wound healing in patients with diabetic foot ulcers (DFUs). Materials and Methods This was a hospital-based, single-center, observational, longitudinal cohort study of 349 Japanese patients (84 women, 265 men; mean (standard deviation) age 62.8 (12.8) years) with DFUs. The endpoint was complete wound healing. The classical Cox proportional model and competing-risks model were used to calculate the hazard ratios (HRs) and the 95% confidence interval (CI) for reaching the endpoint. Results During a median (range) follow-up of 2.3 (0.03-62.3) months, 220 patients (63.0%) reached the endpoint. In the multivariate Cox proportional hazards model, higher PNI was identified as an independent predictor for the endpoint (HRs 1.22, 95% CI 1.01-1.48, p=0.038). In the multivariate competing-risks model analysis, both higher PNI (HRs 1.26, 95% CI 1.03-1.53, p=0.024) and lower CONUT score (HRs 0.80, 95% CI 0.65-0.99, p=0.045) were identified as independent predictors for the endpoint. Similar results were obtained when the PNI and the CONUT score were treated as categorical variables (≥ median or less). Conclusions Nutritional status, as assessed using the PNI and CONUT score, is a novel clinical predictor for wound healing in patients with DFUs. Keywords: Diabetic foot ulcer; Nutritional assessment; Prognostic nutritional index; Controlling Nutritional Status.