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CONUT Score

Controlling Nutritional Status

The CONUT score provides an objective nutritional screening index based on three easily obtainable laboratory parameters: serum albumin, total lymphocyte count, and total cholesterol.

Nutrition Screening GI Oncology Liver Disease
Enter Laboratory Values
Albumin contributes 0, 2, 4, or 6 points
TLC contributes 0, 1, 2, or 3 points
Cholesterol contributes 0, 1, 2, or 3 points
—
CONUT Score (0–12)

Scoring Components

CONUT = Albumin Score + TLC Score + Cholesterol Score
Albumin: ≥3.5 g/dL = 0 pts  |  3.0–3.4 = 2 pts  |  2.5–2.9 = 4 pts  |  <2.5 = 6 pts
TLC: ≥1600/mm³ = 0 pts  |  1200–1599 = 1 pt  |  800–1199 = 2 pts  |  <800 = 3 pts
Cholesterol: ≥180 mg/dL = 0 pts  |  140–179 = 1 pt  |  100–139 = 2 pts  |  <100 = 3 pts

Each parameter reflects a distinct aspect of nutritional status: albumin represents protein reserves, total lymphocyte count reflects immunological competence related to nutritional state, and total cholesterol mirrors energy substrate availability.

Interpretation

CONUT ScoreCategoryRecommended Action
0 – 1 Normal Routine reassessment; no nutritional intervention required
2 – 4 Mild Malnutrition Dietary counselling; reassess within 2–4 weeks; consider oral nutritional supplements
5 – 8 Moderate Malnutrition Formal dietitian referral; consider enteral nutrition support; monitor closely
9 – 12 Severe Malnutrition Urgent multidisciplinary nutritional intervention; consider parenteral nutrition; reassess daily

Clinical Application

The CONUT score has been validated across a wide range of clinical settings within gastroenterology, hepatology, and surgical oncology:

  • Gastrointestinal cancers: Preoperative CONUT ≥ 4 predicts postoperative morbidity, longer hospital stay, and reduced overall survival in colorectal, gastric, and hepatocellular carcinoma. It is an independent prognostic marker in several multivariate analyses.
  • Liver disease: In patients with cirrhosis and hepatocellular carcinoma, the CONUT score correlates with Child-Pugh class and predicts post-hepatectomy complications. It has been proposed as a supplement to conventional liver function scoring.
  • Cardiac surgery: Preoperative malnutrition as defined by CONUT ≥ 5 is independently associated with in-hospital mortality and 30-day readmission following cardiac operations.
  • Perioperative use: The CONUT score is particularly suited to pre-surgical nutritional screening because it uses standard preoperative blood tests, adding no additional cost or burden to the patient workup.
  • Limitations: Albumin and cholesterol may be confounded by acute-phase inflammatory responses, hepatic dysfunction, and lipid-lowering medications. Interpret in clinical context.

References

  1. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38–45.
  2. Gonzalez-Madrono A, Mancha A, Rodriguez FJ, et al. Confirming the validity of the CONUT system for early detection and monitoring of clinical undernutrition: comparison with two logistic regression models developed using SGA and MNA. e-SPEN. 2012;7:e14–e20.
  3. Yoshida N, Baba Y, Shigaki H, et al. Preoperative nutritional assessments by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg. 2016;40(8):1910–1917.
  4. Takagi K, Yagi T, Yoshida R, et al. Preoperative CONUT score predicts postoperative outcomes of patients undergoing hepatectomy for hepatocellular carcinoma. Sci Rep. 2019;9(1):10574.

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